Divide and annex

  • Divide and annex Figure

Question

A 64-year-old man presents with a 1-year history of dysphagia occurring intermittently before progressing to quotidian occurrence. Esophagram and subsequent EGD reveal a 5-cm Zenker’s diverticulum. He undergoes peroral endoscopic myotomy (Z-POEM) dividing the muscular septum and thus annexing the diverticular space into the esophageal lumen, which is uneventful. However, he returns in 1 month with recurrent dysphagia symptoms. Which of the following statements is true?

The Eckardt score is preferred over the Dakkak Bennett score in evaluating symptom severity in this patient. Z-POEM is preferred, given increased safety over endoscopic septotomy. Z-POEM is considered over endoscopic septotomy, as it may hypothetically decrease the risk of symptom recurrence. Z-POEM has recently been promoted over endoscopic septotomy because it is more cost-effective and has an accelerated learning curve.
View picture quiz

More Picture Quizzes

Polyp problem

An 86-year-old man is evaluated for epigastric pain. He has a history of choledocholithiasis requiring ERCPs. MRCP reveals filling defects at the level of the common hepatic duct. On ERCP, surprisingly, the polypoid material (Figure) is extracted from the duct. Direct peroral cholangioscopy is performed with resection of the biliary lesion. Treatment of the base is then performed with radiofrequency ablation. Which of the following is true?
View picture quiz

Internal passage

A 75-year-old man is admitted to the hospital with a high-grade small-bowel obstruction secondary to metastatic cecal cancer invading the ileocecal valve (Figure). Which of the following is false regarding endoscopic management of colon cancer?
View picture quiz

A pill for red

Recently, a novel bleeding sensor system (Figure) was developed to facilitate the triage of patients with suspected upper GI bleeding (UGIB). Which of the following is true regarding UGIB?
View picture quiz

A sleeve within a sleeve

A 57-year-old woman with obesity class III (body mass index: 42 kg/m2) and a history of open cholecystectomy secondary to gangrenous cholecystitis presents for weight regain of 25 kg from nadir weight loss after surgical sleeve gastrectomy 7 years ago. An upper GI series demonstrates gastric sleeve dilation. Given her poor surgical candidacy, she is offered endoscopic sleeve gastroplasty (ESG) with argon plasma coagulation-reinforced suturing (Figure). Which of the following is true about primary ESG for weight loss?
View picture quiz

Ingrowing on me

A 41-year-old woman with a history of Roux-en-Y gastric bypass a decade ago undergoes an endoscopy, given progressive dysphagia. She is found to have a benign gastrojejunostomy stricture, which is treated with a fully covered self-expanding metal stent affixed to the esophageal mucosa with full-thickness sutures. However, a month after placement, dysphagia recurs. Endoscopy reveals significant tissue ingrowth, resulting in upstream flange obstruction. Implementing the stent-in-stent technique (Figure) manages this complication. Which of the following is true regarding the use of stents in the management of GI luminal obstruction?
View picture quiz