The medical gaze

  • The medical gaze Figure 1


A 75-year-old woman presents with dyspeptic symptoms of new onset in the last 4 months. These symptoms persist despite self-treatment with over-the-counter low-dose proton pump inhibitors. She endorses that similar symptoms affected her remotely when she lived in Taiwan and resulted in a workup of a stool test before treatment with antibiotics. She underwent upper endoscopy. Which of the following statements is true?

According to Japanese and European guidelines, it is recommended that 13 views should be obtained during an EGD to ensure blind spots are not missed. Despite initial enthusiasm, artificial intelligence did not offer improvement in EGD quality or a decrease in blind spots and missed lesions during EGD in randomized controlled trials. Given demonstrable superiority in electronic chromoendoscopy techniques and image-enhanced endoscopy, narrow-band imaging endoscopy improves the detection of intestinal metaplasia and small gastric cancer lesions. In gastric endoscopic evaluation, low-magnification narrow-band imaging increases lesion detection and requires a shorter exam time than white-light imaging.
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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?
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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?
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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?
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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?
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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?
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