A pill for red

  • A pill for red Figure 1


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?

The most widely used Glasgow-Blatchford score helps with risk stratification of UGIB because it was designed to predict lesions with higher-risk stigmata (HRS) and thus those requiring urgent endoscopy. The Horibe gAstRointestinal BleedING scoRe (HARBINGER) is a simple score to predict the presence of HRS in patients with UGIB. The Rockall and AIMS65 scores were developed to predict composite outcomes (the need for a blood transfusion or intervention to control bleeding, rebleeding, or death) in the context of UGIB. The recently developed capsule is a U.S. Food and Drug Administration-approved system for the triage of patients with possible UGIB.
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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 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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Writing on the duodenal wall

A 29-year-old patient with a psychiatric history and foreign body ingestions presents with 1 day of moderate to severe abdominal pain. She is normotensive, tachycardic, and febrile. CT scan shows a foreign body consistent with a ballpoint pen in the second portion of the duodenum. Free fluid is in the subhepatic space, but pneumoperitoneum is not present. Attempts at endoscopic retrieval are undertaken with surgical assistance on standby. ASGE guidelines suggest or recommend which of the following for foreign body ingestions within reach of an upper endoscope?
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