Curbside Consultation in Endoscopy: 49 Clinical Questions, Second Edition

Joseph Leung, MD; Simon Lo, MD

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• Question 1: An 81-Year-Old Healthy Male Is Found To Have A 12-Cm Long Segment Barrett’S Esophagus And Several Tiny Raised Lesions, With Moderate To High Grade Dysplasia In One Location. What Do I Tell The Patient? What Therapy Is Appropriate?
• Question 2: A 46-Year-Old Female With Cirrhosis Came In With Severe Upper Gi Bleeding. Her Proximal Stomach Is Filled With Large Clots And Gastric Varices Are Suspected. How Can I Tell For Certain Endoscopically, And What Is The Treatment?
• Question 3: What Are The Essential Tools For Removing Esophagogastric Foreign Bodies, And When Should I Apply These Devices?
• Question 4: You Were Called By The Er Physician Regarding A Female Who Attempted To Commit Suicide By Drinking Toilet Cleaning Solution. There Were Obvious Burns Around The Mouth And Tongue. What Would You Do Next?
• Question 5: What Is The Current Recommendation For Endoscopic Surveillance Of Barrett’S Esophagus, And How Can We Improve The Results With The Current Technologies?
• Question 6: What Should I Do If I Have Inadvertently Perforated The Viscus During An Endoscopy?
• Question 7: What Is The Current Expert Opinion On What Hemostasis Technique To Use In Treating A Visible Vessel Or Dieulafoy Lesion? When Should I Involve A Surgeon?
• Question 8: What Do People Do For The Treatment Of Achalasia These Days? Does It Matter If The Symptoms Are Severe Or If The Patient Is Elderly?
• Question 9: A 65-Year-Old Male With Long-Standing Gerd Complained Of Recent Onset Of Progressive Difficulty Swallowing (Especially Solids) And Subjective Weight Loss. How Should I Evaluate The Patient?
• Question 10: Several Trips To The Er For A 56-Year-Old Mechanic For Sob And Iron Deficient Anemia Revealed Positive Fobt, But Egd And Colonoscopies Did Not Identify The Bleeding Source. He Takes Nsaids Regularly For Arthritis Pain. Is There A Role For Enteroscopy?
• Question 11: A 59-Year-Old Professor Had Dyspepsia And Subjective Weight Loss. He Was Treated Previously For H Pylori Infection. Egd And Biopsies Showed Chronic Inflammation With Intestinal Metaplasia And One Focal Area Of Low-Grade Dysplasia. What Do I Do?
• Question 12: A 38-Year-Old Mildly Obese Female Presented With Gerd Symptoms And Was Found To Have A Persistently Elevated Amylase Level Around 250 Iu/L (Normal < 125) But Normal Lipase. How Should I Manage This Patient?
• Question 13: A 35-Year-Old Female Presented With Epigastric Pain, Difficulty Swallowing, And Subjective Fever 1 Month After Gastric Bypass Surgery. She Was Seen In The Er Because Of Recent Hematemesis. What Do I Do?
• Question 14: A 45-Year-Old Alcoholic Was Admitted With Abdominal Pain, Coffee Ground Emesis, And Mild Anemia. Upper Endoscopy Shows A Few Polypoid Masses In The Gastric Body And Pigmentations In The Antrum. What Should I Do?
• Question 15: A 45-Year-Old Patient With Known Hepatitis C Was Admitted Because Of Massive Upper Gi Bleeding. What Should I Do?
• Question 16: Bougienage, Balloon Dilation, Cautery Cutting, Stenting, And Steroid Injection Have All Been Described To Treat Benign Strictures Of The Gi Tract. Is There A Right Way Of Doing This?
• Question 17: Which Of My Patients With Ulcerative Colitis Need “Surveillance” Colonoscopy? How Should The Procedure Be Performed?
• Question 18: I Had A Difficult Colonoscopy And No Matter What I Tried, I Just Could Not Reach The Cecum. I Maxed Out On Iv Sedations And Have No Anesthesiology Support. Can You Help Me?
• Question 19: A 68-Year-Old Male With Significant Comorbidities Presented With Weight Loss And New Onset Vomiting. Investigation Showed Colonic Obstruction With Poorly Differentiated Adenocarcinoma Involving The Sigmoid Colon. Do I Consider Stenting?
• Question 20: A 58-Year-Old Female Underwent A Screening Colonoscopy That Showed A 2.5-Cm Flat Polyp In The Proximal Ascending Colon. I Tattooed The Area And Biopsied The Polyp, Which Was Initially Reported As Hyperplastic. What Should I Do?
• Question 21: What Is The Role Of Chromoendoscopy In Screening Colonoscopy? Will It Help To Differentiate Different Types Of Polyps, And Is It Useful For Proximal Serrated Polyps?
• Question 22: I Have Trouble Doing A Complete Colonoscopy In Some Of My Patients Because Of Poor Bowel Preparation. What Should I Do To Insure A Properly Prepared Colon?
• Question 23: A 55-Year-Old Veteran Had A Ruptured Gallbladder And A Difficult Cholecystectomy. Postoperatively, The Patient Had Persistent Bile Leakage Despite Months Of Multiple Biliary Stenting. What Can I Do?
• Question 24: A 65-Year-Old Male On Plavix Following A Recent Mi And Coronary Stenting Was Seen In The Er With Fever, Pain, Jaundice, And A Wbc Of 18,000. Us Showed A Dilated Bile Duct Of 15 Mm And A Gallbladder Full Of Stones. Mrcp Revealed A 15-Mm Stone In The Distal Cbd. What Would You Do?
• Question 25: What Is The Best Endoscopic Method To Diagnose Pancreatic Cancer? What Is The Best Way To Sample Tissue To Diagnose Suspected Bile Duct Cancer?
• Question 26: A 68-Year-Old Man With A Klatskin’S Tumor Was Referred For Consideration Of Ercp And Palliative Drainage. How Should I Manage The Patient?
• Question 27: An Elderly Patient With Multiple Medical Problems Presents With Acute Pancreatitis And Stones In The Gallbladder. Lfts Show Ast Of 90 And Alt Of 95, Both Declining. Mrcp Shows No Cbd Stones Or Ductal Dilation. Is Ercp Indicated?
• Question 28: I Have A Patient With Biliary-Type Pain, But No Other Evidence Of Bile Duct Disease (Normal Diameter Duct On Ultrasound, Normal Liver Function Tests). How Should Such A Patient Be Managed?
• Question 29: How Can We Accurately Determine The Appropriate Length Of The Stent To Use In A Patient With A Bile Duct Stricture?
• Question 30: A 56-Year-Old Female Presents With Recurrent Ruq Pain, Impaired Lfts, Elevated Alkp, And Transaminases. She Had A Prior Ercp And Possible Biliary Papillotomy For Similar Complaints But She Does Not Recall The Diagnosis. What Should I Do?
• Question 31: My Accountant, Whose Ulcerative Colitis Is In Good Control On Maintenance 5 Asa Therapy, Called Because His Lfts Were Elevated. He Had No History Of Jaundice, But New Onset Of Itching. What Should I Do?
• Question 32: My 35-Year-Old Patient Who Had A Cholecystectomy 5 Years Ago During Her Gastric Bypass Surgery Presents With Abdominal Pain And Impaired Lfts. Ct Showed A 15-Mm Cbd With A Distal Cbd Stone. Ercp Was Unsuccessful Using A Pediatric Scope. Can You Help?
• Question 33: A 48-Year-Old Male Had Liver Transplantation 9 Months Ago For Chronic Hep C Cirrhosis. He Presented Recently With Recurrence Of Jaundice And Impaired Lfts. How Should I Manage This Patient?
• Question 34: A 68-Year-Old Banker Who Had A Prior Whipple For Periampullary Cancer Had Recurrent Abdominal Pain And Fever For 3 Years. Each Resolved With Antibiotics. Lfts Are Impaired And Ct Scan Shows Dilated Intrahepatic Ducts And A Tubular Structure In The Pancreas. What Should I Do?
• Question 35: A 78-Year-Old Vietnamese Woman Who Collapsed At Home Was Found To Be Febrile And In Shock With A Systolic Bp Of 80 Mm Hg. She Is Mildly Jaundiced With Abdominal Guarding. How Would You Manage Her?
• Question 36: My 68-Year-Old Patient With Ms Presents With Dyspeptic Symptoms And Loose Stools. Imaging Showed A Dilated Pancreatic Duct And Extensive Calcification In The Head Of The Pancreas. Symptoms Responded Partly To Pancreatic Enzyme Supplement. What Should I Do Next?
• Question 37: A 12-Year-Old Patient Has A 5-Year History Of Recurrent “Acute Pancreatitis,” Managed Conservatively With Pancreatic Enzymes Supplement. Ct Reveals Mildly Dilated Pancreatic Duct With A Possible Stone In The Head Of The Pancreas. What Else Can I Do?
• Question 38: A 25-Year-Old Female Presents With Recurrent Abdominal Pain And Mildly Elevated Serum Amylase And Lipase Levels, Normal Lfts. Abdominal Imaging Shows Normal Size Cbd, Pd, And No Obvious Stones In The Gallbladder. What Should I Do Next?
• Question 39: What Is The Best Treatment For Duodenal Or Ampullary Adenoma, And What Is The Current Recommendation For Surveillance After Treatment?
• Question 40: What Should Be The Sequence Of Investigations For A Patient With Recurrent, Unexplained Pancreatitis?
• Question 41: A 56-Year-Old Female With Nausea And Vomiting Has A Mildly Elevated Bilirubin But Normal Amylase And Lipase. Ct Shows Thickening Of The Duodenum And Mildly Dilated Cbd. Attempted Ercp Shows A Tight Ulcerative Stenosis Of 1St/2Nd Part Of The Duodenum. What Should I Do?
• Question 42: How Do We Manage A Patient With A 10-Cm Pseudocyst Who Is Currently Asymptomatic?
• Question 43: Do All Pancreatic Cysts Need Eus Imaging, And Do They All Need To Be Aspirated For Analysis? Are There Even Standard Criteria To Determine Their Origins?
• Question 44: Our Endosonographer Frequently Detects Vague Hypoechoic Pancreatic Lesions, But Does Not Perform Fine Needle Aspiration—He Recommends Follow Up Eus In 3 Months. How Many Follow Up Exams Are Needed? Are Fine Needle Aspirations Unsafe?
• Question 45: When Is Eus Necessary For A Newly Diagnosed Cancer Of The Esophagus, Stomach, Colon, Or Pancreas?
• Question 46: A 35-Year-Old Mechanic Is Complaining Of New Onset Epigastric Pain After Taking Motrin. Egd Shows Mild, Nonerosive Antral Gastritis, And A 1-Cm Submucosal Mass In The Proximal Antrum. Biopsies Showed Chronic Inflammation. What Should I Do?
• Question 47: In True Obscure Gi Bleeding, What Should I Do If A Capsule Endoscopy And Upper And Lower Endoscopies Are Unrevealing?
• Question 48: What Is A Reliable Method To Estimate The Location Of A Lesion Found On Capsule Endoscopy?
• Question 49: If I Suspect A Small Bowel Lesion, How Do I Choose Among Small-Bowel Series, Capsule Endoscopy, Ct Enterography, And Double-Balloon Enteroscopy As The Diagnostic Test?

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• $92.95
• ISBN 10 1-61711-047-7
• ISBN 13 978-1-61711-047-4
• 272 pp Soft Cover
• Pub. Date: 2014
• Order# 70474