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  1. An anal lesion

    A debilitated 83-year-old woman complains of anal discomfort, tenesmus, and rectal bleeding. She also reports that a mass prolapses during bowel movements. Colonoscopy is performed, and the pictured lesion is seen. After a detailed discussion with the patient, a hybrid ESD is successfully performed. Which of the following is the most likely diagnosis?
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  2. Ancient history

    A 72-year-old woman presents for evaluation of a persistent headache. CT scan reveals a 2- x 2-cm hepatic lesion with enhancement during the portal venous phase. Liver chemistries are normal, and an EUS is performed. An aneurysm is seen that acts as an intrahepatic portosystemic shunt. The presence of ligamentum venosum is confirmed. Which of the following represents the embryologic origin of the ligamentum venosum?
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  3. Breaking stones

    A 74-year-old man with chronic pancreatitis presents with abdominal pain and an elevated serum lipase. A 15-mm stone is seen within the main pancreatic duct along with a 3-cm stricture. Peroral pancreatoscopy is performed with laser-assisted stricturoplasty and lithotripsy with clinical improvement. Which of the following is the most accurate statement regarding chronic pancreatitis?
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  4. Red light, yellow light

    An 82-year-old woman presents with painless hematochezia. She has had previous episodes, each treated with endoscopic therapy. Urgent colonoscopy with distal cap attachment is performed, but the culprit diverticulum cannot be identified. Red dichromatic imaging helps identify the bleeding lesion. Which of the following endoscopic therapies is used to achieve hemostasis in this case?
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  5. Complications with capsules

    A 61-year-old woman with a history of cervical cancer and years of chronic abdominal pain undergoes motility capsule endoscopy. This procedure is complicated by capsule retention, documented on multiple imaging studies over 1.5 years. She eventually undergoes retrograde balloon enteroscopy that demonstrates an ulcerated ileal stricture with the capsule seen upstream. Removal is accomplished by overtube-assisted lumen-apposing metal stent placement. Which of the following is a contraindication to capsule endoscopy?
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  6. Cancer recurrence palliation

    A 91-year-old man with history of colon cancer who underwent a right hemicolectomy presents with worsening abdominal pain and inability to tolerate oral intake. CT shows tumor recurrence at the anastomosis with evidence of high-grade small-bowel obstruction. Colonoscopy is pursued for possible endoscopic decompression. If enteral stent placement across the stricture is not feasible, what alternative endoscopic therapy could provide palliative relief?
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  7. Double-barreled dysphagia

    A 27-year-old with history of reflux presents with progressive dysphagia to both solids and liquids and significant weight loss. Upper endoscopy reveals this finding in the esophagus. What is the next best step in management?
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  8. Challenging resection

    A 45-year-old woman presents with globus and undergoes upper endoscopy. A 2.5-cm subepithelial lesion is seen in the postcricoid area 10 cm from the incisors. Submucosal tunneling endoscopic resection (STER) is performed, and the lesion as seen in the image is brought into the lumen prior to resection of the final muscle fibers. Pathology reveals a fibrosarcoma. What characteristic of the tumor makes STER more technically challenging than usual?
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  9. An impressive lesion

    A 51-year-old healthy woman undergoes her initial screening colonoscopy, and a rectal lateral spreading tumor (LST) is identified. She is referred to another center for resection. There, as an alternative to endoscopic submucosal dissection, a multistep band ligation resection is performed. How should an LST be managed prior to referral for resection?
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  10. If at first you don’t succeed…

    A 41-year-old woman with a remote history of Roux-en-Y gastric bypass for weight loss presents with failure to thrive. Using EUS guidance, the excluded gastric body is identified and insufflated with a saline contrast solution, and a lumen-apposing metal stent is placed. Immediate arterial bleeding is noted. Which of the following modalities was used to achieve hemostasis in this case?
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