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  1. Bugs and bloating

    A 47-year-old woman presents with chronic abdominal bloating and belching. Patient denies use of carbonated beverages, artificial sweeteners, and has been dairy-free. She had a negative colonoscopy prior to presenting to your clinic for evaluation. You perform an upper endoscopy procedure with duodenal aspiration for small intestinal bacterial overgrowth (SIBO). Which of the following statements about SIBO is true?
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  2. An urgent solution

    A 72-year-old woman with chronic hepatitis C infection (viral load 5 million) and cirrhosis was recently diagnosed with hepatocellular carcinoma. She presents to the emergency deparment overnight with significant hematemesis of red blood and clots. The patient is resuscitated, intubated for airway protection, and emergent upper endoscopy is performed. The gastric varix starts to bleed, and you decide to inject it with n-buytl-2-cyanoacrylate glue mixed with lipiodol for hemostasis. What is the purpose of mixing cyanoacrylate glue with lipoidal?
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  3. Difficult cannulation assistance

    An 80-year-old presented with jaundice secondary to a hilar mass. He subsequently underwent ERCP. What technique for difficult biliary cannulation is being utilized?
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  4. A rectal lesion goes viral

    A 42-year-old woman presented with hematochezia and constipation. She underwent colonoscopy with this endoscopic finding on retroflexion. What infectious agent has this entity been associated with?
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  5. A challenging follow-up

    An 85-year-old man presented with abdominal pain, nausea, and vomiting. CT revealed a 10-mm stone in the distal common bile duct with marked upstream dilation to 20 mm. An ERCP was performed, and the stone was removed. A biliary stent was placed. Six weeks later a repeat ERCP was planned. Which of the following statements about this follow-up ERCP is true?
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  6. A hint seen in hindsight

    A 34-year-old man presented with longstanding dysphagia and regurgitation. Endoscopy showed a dilated and tortuous esophagus with no significant resistance at the gastroesophageal junction. Evaluation with a timed barium swallow and manometry are shown in the image. What diagnosis is this constellation of testing results most consistent with?
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  7. To test or not to test?

    A 58-year-old woman is found to have an abnormal appearing ampulla on routine upper endoscopy. Biopsies from the ampulla are negative for malignancy. Endoscopic ampullectomy is performed, and the pathology specimen is consistent with moderately differentiated adenocarcinoma. Which of the following statements regarding tumor testing is true?
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  8. Not a standard drive-by

    A 71-year-old man with a history of superficial squamous cell carcinoma of the pharynx presents for surveillance EGD. An area of abnormal mucosa is noted in the posterior oro-pharynx before the endoscope is introduced into the esophagus. Which of the following is the most likely diagnosis?
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  9. A mysterious rectal lesion

    A 40-year-old woman G0P0 presents with a 2-month history of increased bowel habit and sense of incomplete evacuation. She denied hematochezia or dysmenorrhea. Colonoscopy revealed the rectal lesion below. Biopsy results were negative for malignancy. She undergoes EUS with fine-needle aspiration of the rectal lesion. Which of the following is the most likely diagnosis?
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  10. A hard truth to swallow

    A 10-month-old female has a witnessed episode of choking, but her parents say they watch her diligently and have baby-proofed the house. Her physical exam is normal with a clear posterior oro-pharynx and stable vital signs. Which of the following statements is most accurate regarding pediatric esophageal foreign body ingestion?
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