FES written exam/ FES Exam Questions and answers
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Time frames for upper endoscopy - Familiar polyposis - Ans 1-2 years
Patient positioning for ERCP - Ans prone position with the head turn toward the right shoulder
patient positioning for upper endoscopy - Ans left side down, head slightly up.
Maneuver to look at the GE junction - Ans J maneuver (tip up), rotate the shaft of the scope
CCW and withdraw, pulling the scope into the proximal body and cardia, rotate the scope 360
around the GE jx,
techniques to decrease post ERCP pancreatitis - Ans selective bile duct cannulation w/
guidewire, stenting pancreatic dut w/ stent or guidewire for difficult CBD cannulation, limiting
contrast injection into the pancreatic duct
Technique for billiary sphincterotomy - Ans apply pressure w/ cutting wire toward 11 o'clock
direction, continue the sphincterotomy until the intramural portion is cut. Use blended current
with cutting and coag at 15-20J. Alt: can use balloon dilation but a/w higher rate of post-ECRP
pancreatitis
Direction of pancreatic cannulation during ERCP - Ans 1 to 3 o'clock position
When to stop warfarin before ERCP - Ans stop 5 days before and switch to heparin or lovenox
if peri-procedural anticoagulation is required. This can be stopped a day prior to the procedure
rate of post ERCP pancreatitis - Ans 3-5%
, Timing of colonoscopy for first degree relative w/ CRC or adenomas prior to age 60 - Ans
colonoscopy at age 40 or 10 years before the youngest affected relative, whichever is earlier.
Then repeat every 5 yrs
Indications for ECRP - Ans Tissue sampling - bile duct, pancreatic duct, ampulla bx
chronic pancreatitis/divisum
pancreatic malignancy
billiary malignancy
Benign strictures
Ductal disruption/injury
Jaundice
cholangitis
gallstone pancreatitis
dilated CBD
maneuvers to enter IC valve - Ans rotate the scope until the valve is at the bottom of the visual
field, look down into the valve, gently insuflate air to open up the valve, OR retroflex the tip in
the cecum and shorten the scope (hook the IV valve)
cancer detection rate of brush biopsy - Ans 20-60%
band ligation vs sclerotherapy for esophageal varices - Ans equal efficacy but baldn ligation
has lower complication rate.
cancer detection rate of needle aspiration - Ans 6-30%
, how long after sphincterotomy can the bleeding complication manifest? - Ans immediate up
to 14 days
relative contraindications for colonoscopy - Ans anal fissure, recent MI, PE, large bowel
obstruction
Time frames for upper endoscopy - esophageal varices s/p sclerotherapy and banding - Ans
q6-8weeks
Indications for screening colonoscopies - Ans over 50 y/o, repeat every 10 years
Time frames for upper endoscopy - pernicious anemia - Ans single endoscopy w/o f/u
complication rate of diagnostic colonoscopy - Ans 1:1500
Time frames for upper endoscopy - Barett's esophagus (high risk) - Ans >3 cm, circumferential
- yearly
low grade dysplasia - every 6 mo
Factors a/w rebleeding after endoscopic procedures - Ans endoscopic stigmata w/ active
bleeding and visible vessles having the highest rebleeding risk, pigmentation of a red, dark or
white color signifying gradually maturing clots, ulcer size >2cm and proximity to major arteries,
age (>60yo), comorbid status, shock, coagulopathy, anemia
removal timing for pancreatic duct stent - Ans 3 weeks
Definition of post ECRP pancreatitis - Ans increased abdominal pain a/w elevation of serum
amylase >3x NL
, relative icontraindications ifor iERCP i- i Ans i cardiopulmonary iinstability, ipregnancy, icoagulopathy
screening itimeline ifor iFAP i- i Ans i lower iand iupper iendoscopy istarting iin ithe iearly iteen iyears
Time iframes ifor iupper iendoscopy i- iBarrett's iesophagus i(low irisk) i- i Ans i <3cm, ino idysplasia,
ievery i1-2 iyears
absolute icontrainditions ifor iERCP i- i Ans i none
maneuver ito iget ito ithe isecond iportion iof ithe iduodenum i- i Ans i dial iup iand iright, iwith iclockwise
itorque
what iare iimportant ivariables ifor iachieving ihemostasis iusing icoaptive itechniques? i- i Ans i probe
isize, iforce iof iapplication, ipower isetting, iduration iof ienergy idelivery
How ido iyou iconfirm ithat iyou iare iin ithe icecum i- i Ans i visualization iof iappendiceal iorifice,
i"crow's ifoot" iconfluence iof itaenia, ipalpate iRLQ&transillumination,
volume iof iepi iinjection i- i Ans i up ito i1cc iin i0.5-1cc ialiquots
max ivessel isize ifor ieffective icoaptive itechnique i- i Ans i d=2mm
Why ishould ia isupine iposition ibe iavoided iin iERCP iunless ithe ipatient icannot iturn? i- i Ans i a/w
icannulation idifficulty
When iis iballon itemponde iuseful? i- i Ans i for icontrolling ibleeding iafter iendoscopic
isphincterotomy iparticularly iin isettings iwhere ia ibiliary istone iextraction iballoon iis ialready iin iuse
Newest RATED A+ 100% VERIFIED CORRECT NEW!!
Time frames for upper endoscopy - Familiar polyposis - Ans 1-2 years
Patient positioning for ERCP - Ans prone position with the head turn toward the right shoulder
patient positioning for upper endoscopy - Ans left side down, head slightly up.
Maneuver to look at the GE junction - Ans J maneuver (tip up), rotate the shaft of the scope
CCW and withdraw, pulling the scope into the proximal body and cardia, rotate the scope 360
around the GE jx,
techniques to decrease post ERCP pancreatitis - Ans selective bile duct cannulation w/
guidewire, stenting pancreatic dut w/ stent or guidewire for difficult CBD cannulation, limiting
contrast injection into the pancreatic duct
Technique for billiary sphincterotomy - Ans apply pressure w/ cutting wire toward 11 o'clock
direction, continue the sphincterotomy until the intramural portion is cut. Use blended current
with cutting and coag at 15-20J. Alt: can use balloon dilation but a/w higher rate of post-ECRP
pancreatitis
Direction of pancreatic cannulation during ERCP - Ans 1 to 3 o'clock position
When to stop warfarin before ERCP - Ans stop 5 days before and switch to heparin or lovenox
if peri-procedural anticoagulation is required. This can be stopped a day prior to the procedure
rate of post ERCP pancreatitis - Ans 3-5%
, Timing of colonoscopy for first degree relative w/ CRC or adenomas prior to age 60 - Ans
colonoscopy at age 40 or 10 years before the youngest affected relative, whichever is earlier.
Then repeat every 5 yrs
Indications for ECRP - Ans Tissue sampling - bile duct, pancreatic duct, ampulla bx
chronic pancreatitis/divisum
pancreatic malignancy
billiary malignancy
Benign strictures
Ductal disruption/injury
Jaundice
cholangitis
gallstone pancreatitis
dilated CBD
maneuvers to enter IC valve - Ans rotate the scope until the valve is at the bottom of the visual
field, look down into the valve, gently insuflate air to open up the valve, OR retroflex the tip in
the cecum and shorten the scope (hook the IV valve)
cancer detection rate of brush biopsy - Ans 20-60%
band ligation vs sclerotherapy for esophageal varices - Ans equal efficacy but baldn ligation
has lower complication rate.
cancer detection rate of needle aspiration - Ans 6-30%
, how long after sphincterotomy can the bleeding complication manifest? - Ans immediate up
to 14 days
relative contraindications for colonoscopy - Ans anal fissure, recent MI, PE, large bowel
obstruction
Time frames for upper endoscopy - esophageal varices s/p sclerotherapy and banding - Ans
q6-8weeks
Indications for screening colonoscopies - Ans over 50 y/o, repeat every 10 years
Time frames for upper endoscopy - pernicious anemia - Ans single endoscopy w/o f/u
complication rate of diagnostic colonoscopy - Ans 1:1500
Time frames for upper endoscopy - Barett's esophagus (high risk) - Ans >3 cm, circumferential
- yearly
low grade dysplasia - every 6 mo
Factors a/w rebleeding after endoscopic procedures - Ans endoscopic stigmata w/ active
bleeding and visible vessles having the highest rebleeding risk, pigmentation of a red, dark or
white color signifying gradually maturing clots, ulcer size >2cm and proximity to major arteries,
age (>60yo), comorbid status, shock, coagulopathy, anemia
removal timing for pancreatic duct stent - Ans 3 weeks
Definition of post ECRP pancreatitis - Ans increased abdominal pain a/w elevation of serum
amylase >3x NL
, relative icontraindications ifor iERCP i- i Ans i cardiopulmonary iinstability, ipregnancy, icoagulopathy
screening itimeline ifor iFAP i- i Ans i lower iand iupper iendoscopy istarting iin ithe iearly iteen iyears
Time iframes ifor iupper iendoscopy i- iBarrett's iesophagus i(low irisk) i- i Ans i <3cm, ino idysplasia,
ievery i1-2 iyears
absolute icontrainditions ifor iERCP i- i Ans i none
maneuver ito iget ito ithe isecond iportion iof ithe iduodenum i- i Ans i dial iup iand iright, iwith iclockwise
itorque
what iare iimportant ivariables ifor iachieving ihemostasis iusing icoaptive itechniques? i- i Ans i probe
isize, iforce iof iapplication, ipower isetting, iduration iof ienergy idelivery
How ido iyou iconfirm ithat iyou iare iin ithe icecum i- i Ans i visualization iof iappendiceal iorifice,
i"crow's ifoot" iconfluence iof itaenia, ipalpate iRLQ&transillumination,
volume iof iepi iinjection i- i Ans i up ito i1cc iin i0.5-1cc ialiquots
max ivessel isize ifor ieffective icoaptive itechnique i- i Ans i d=2mm
Why ishould ia isupine iposition ibe iavoided iin iERCP iunless ithe ipatient icannot iturn? i- i Ans i a/w
icannulation idifficulty
When iis iballon itemponde iuseful? i- i Ans i for icontrolling ibleeding iafter iendoscopic
isphincterotomy iparticularly iin isettings iwhere ia ibiliary istone iextraction iballoon iis ialready iin iuse
