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  1. 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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  2. 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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  3. 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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  4. Giant gastric polyp

    A 73-year-old man with atrial fibrillation on antithrombotic therapy and congestive heart failure presents with weight loss and iron deficiency anemia. He undergoes bidirectional endoscopy and video capsule endoscopy that reveal only this large polyp in the stomach. The polyp is described as sessile, smooth, and lobulated and is located along the greater curvature and posterior gastric wall. Biopsies suggest a benign hyperplastic polyp, but given the size, the patient is referred for resection. Pathology returns as a hamartomatous polyp. What polyposis syndrome is this type of polyp usually associated with?
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  5. Diarrheal disaster

    A 52-year-old woman with a history of metastatic gastric cancer presents with gastric outlet obstruction. She undergoes EUS-guided gastrojejunostomy for relief. A month later, she is readmitted with abdominal pain, distension, and new-onset diarrhea. CT shows progression of disease with ascites. Paracentesis improves her abdominal pain, but her diarrhea persists. Upper endoscopy is performed. What is the cause of her diarrhea?
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  6. Small-bowel bleeding

    A 75-year-old man presents with severe iron deficiency anemia. Single-balloon enteroscopy reveals a 12-mm reddish tumor in the third portion of the duodenum. What is true about this lesion?
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  7. Ubi pus, ibi evacua

    Which of the following is true about acute cholecystitis diagnosis and management?
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  8. The medical gaze

    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?
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  9. Divide and annex

    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?
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  10. Into the tunnel

    A 50-year-old man is referred to the gastroenterology clinic for longstanding nausea and vomiting. He endorses a longstanding history of diabetes, which has only recently been well-controlled. The physical exam is unremarkable, and he denies weight loss.
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