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VideoGIE Image Quiz

  1. Measures of portal hypertension

    68-year-old woman with morbid obesity and NASH cirrhosis presented for evaluation to discuss endoscopic options for weight loss. To assess her risk of decompensation, she underwent EUS-guided measurement of her portal pressure gradient. How is the portal pressure gradient measured in this procedure?
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  2. Entrance into excluded spaces

    An 84-year-old woman with history of RYGB and significant comorbidities including interstitial lung disease complicated by severe pulmonary hypertension and severe aortic stenosis presented with right upper quadrant pain. CT showed common duct stones and cholecystitis. Conservative management with percutaneous drainage was inadequate. Given this, EUS-directed transgastric endoscopic retrograde cholangiopancreatography (EGDE) with EUS-guided gallbladder drainage were performed. What entity is circled on the endoscopic image?
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  3. Challenging altered anatomy

    A 73-year-old woman with history of pylorus-preserving pancreaticoduodenectomy with Billroth-II reconstruction for early ampullary adenocarcinoma presented with epigastric pain. Representative CT and MRI images are shown above. Which of the following is the next best step in management?
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  4. Baffling bleeder

    An 81-year-old man on anticoagulation presented with melena. An EGD was performed. A large amount of fresh blood and clot were identified. A pulsatile actively bleeding source was eventually identified. What device was used in this situation to identify the source of blood loss more easily?
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  5. A duodenal switch back

    A 43-year-old woman is hospitalized with diarrhea, failure to thrive, and ongoing weight loss. She had a bilio-pancreatic diversion procedure done for obesity 9 years prior. Her post-surgical anatomy is reversed by EUS-guided LAMS placement with good clinical effect. Patients with bilio-pancreatic diversion are at risk for trace mineral deficiency. Deficiency of which of the following trace minerals can lead to skeletal muscle dysfunction and cardiomyopathy?
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  6. An interesting obstruction

    A 71-year-old woman presents with abdominal pain and vomiting. Endoscopy reveals a diospyrobezoar obstructing the lumen of the proximal duodenum. The bezoar is removed using a combined mechanical and chemical approach. Diospyrobezoars form as an accumulation of which of the following?
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  7. Recurrent hypoglycemia

    A 44-year-old man with recurrent hypoglycemia is admitted for evaluation. CT scan was unrevealing but EUS identified a 2- x 2-cm pancreatic neck mass, and fine-needle aspiration was performed. Cytology confirmed an insulinoma, and the pancreatic lesion was ablated with ethanol. Which of the following is the most accurate statement?
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  8. A heavy metal issue

    A 58-year-old woman presents with new onset dysphagia and unintentional weight loss. One year ago, she had an antireflux procedure done. Endoscopy done with fluoroscopy shows erosion and migration of LINX, a magnetic sphincter augmentation device. The device is removed endoscopically. Which of the following is the most accurate statement about LINX?
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  9. A weighty warning

    A 40-year-old woman with prior history of endoscopic sleeve gastroplasty (ESG) presented with loss of satiety and weight regain. An EGD was performed, and a representative image of the stomach is shown. What is the most likely cause of this patient’s symptoms?
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  10. A gastric growth

    An 83-year-old man with history of diabetes and prostate cancer presented with abdominal pain, fever, and leukocytosis. CT imaging of the abdomen showed an abnormality within the stomach. The endoscopic view of a similar area is shown. What is the most likely diagnosis?
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