GI Endoscopy & Procedural Care 2 — Questions and Answers
Question 1: What is the gold standard diagnostic method for confirming celiac disease?
- Serum IgA anti-tTG antibody test alone
- Small bowel biopsy via upper endoscopy showing villous atrophy (Correct answer)
- Fecal fat quantification over 72 hours
- Hydrogen breath testing after gluten challenge
Correct answer: Small bowel biopsy via upper endoscopy showing villous atrophy
Small bowel biopsy obtained via upper endoscopy demonstrating villous atrophy, crypt hyperplasia, and increased intraepithelial lymphocytes remains the gold standard for celiac disease diagnosis.
Question 2: Which bowel preparation agent is most widely recommended before colonoscopy due to its safety profile?
- Fleet phosphosoda enema alone
- Polyethylene glycol (PEG) electrolyte solution (Correct answer)
- Magnesium citrate combined with stimulant laxatives only
- 48-hour clear liquid diet without additional agents
Correct answer: Polyethylene glycol (PEG) electrolyte solution
Polyethylene glycol (PEG) electrolyte solution provides effective bowel cleansing with minimal electrolyte disturbances, making it safe across most patient populations including those with renal or cardiac disease.
Question 3: Barrett's esophagus with high-grade dysplasia is found on EGD. What is the most appropriate next intervention?
- Annual surveillance endoscopy without treatment
- Endoscopic eradication therapy such as radiofrequency ablation (Correct answer)
- High-dose proton pump inhibitor therapy only
- Discharge with dietary modification and antacids
Correct answer: Endoscopic eradication therapy such as radiofrequency ablation
High-grade dysplasia in Barrett's esophagus requires endoscopic eradication therapy (e.g., radiofrequency ablation or endoscopic mucosal resection) due to significant risk of progression to adenocarcinoma.
Question 4: In colonoscopy practice, what does 'tattooing' a lesion mean?
- Applying a dye spray for chromoendoscopy visualization
- Injecting India ink adjacent to a lesion to mark its location for future identification (Correct answer)
- Permanently staining a polyp before removal
- Marking the patient's skin above the lesion site
Correct answer: Injecting India ink adjacent to a lesion to mark its location for future identification
Colonic tattooing involves submucosal injection of India ink or a similar permanent marker adjacent to a lesion so it can be reliably identified during subsequent colonoscopy or surgery.
Question 5: A patient develops oxygen desaturation to 88% during upper endoscopy with conscious sedation. What is the first intervention?
- Administer a rapid IV fluid bolus of 500mL normal saline
- Administer supplemental oxygen and stimulate the patient to breathe (Correct answer)
- Immediately perform endotracheal intubation
- Discontinue monitoring and observe for 2 minutes
Correct answer: Administer supplemental oxygen and stimulate the patient to breathe
Supplemental oxygen and physical stimulation (jaw thrust, verbal stimulation) are the first-line interventions for desaturation during conscious sedation, following a stepwise airway management approach.
Question 6: What is the recommended surveillance colonoscopy interval after removal of a single tubular adenoma measuring less than 10mm with low-grade dysplasia?
- 6-12 months
- 3-5 years (Correct answer)
- 10 years
- No further colonoscopy surveillance is needed
Correct answer: 3-5 years
Current USMSTF guidelines recommend repeat colonoscopy in 3-5 years after removal of one or two small tubular adenomas with low-grade dysplasia, given their low malignant potential.
Question 7: Which endoscopic technique is used to resect large sessile or flat polyps by injecting fluid into the submucosa before excision?
- Endoscopic mucosal resection (EMR) (Correct answer)
- Push enteroscopy
- Chromoendoscopy with acetic acid
- Narrow band imaging (NBI)
Correct answer: Endoscopic mucosal resection (EMR)
Endoscopic mucosal resection (EMR) lifts large sessile or flat lesions by submucosal fluid injection, creating a safety cushion that separates the lesion from the muscularis propria before snare resection.
GI Endoscopy & Procedural Care 2
What is the gold standard diagnostic method for confirming celiac disease?