Upper GI

A 42-year-old with chronic heartburn has biopsy-proven Barrett’s esophagus without dysplasia. Best surveillance plan?

A 28-year-old man has progressive dysphagia to both solids and liquids and “bird-beak” on barium swallow. Best next step to confirm?

For type II achalasia in a young, fit patient, which definitive therapy has highest durable success?

A patient with regurgitation and respiratory symptoms from massive paraesophageal hernia (type III). Best management?

After Heller myotomy, which wrap is preferred to limit reflux while preserving swallow?

A 65-year-old alcoholic presents with severe chest pain after forceful vomiting; CXR shows left pleural effusion and mediastinal air. Diagnosis?

Initial step in management of suspected esophageal perforation within hours of onset?

Best test to stage depth of invasion (T stage) in esophageal cancer after diagnostic EGD/biopsy?

Which patient with GERD most benefits from antireflux surgery?

A 56-year-old with dysphagia and weight loss has distal esophageal adenocarcinoma. Standard neoadjuvant strategy for resectable disease?

A 44-year-old has refractory peptic esophageal stricture after multiple dilations. Adjunct to reduce recurrence?

Best initial test for suspected Zenker diverticulum with regurgitation of undigested food?

A 70-year-old with upper GI bleed and hemodynamic instability. First resuscitative target?

Bleeding posterior duodenal ulcer—arterial source most likely?

Perforated anterior duodenal ulcer on upright CXR (free air). Best immediate management in stable patient?

H. pylori–positive duodenal ulcer after endoscopic therapy. Best strategy?

A 63-year-old with refractory gastric outlet obstruction from chronic peptic disease. Preferred surgical option?

Marginal ulcer 10 months after Roux-en-Y gastric bypass. Contributing risk to address first?

Internal hernia after RYGB suspected (postprandial crampy pain, intermittent obstruction). Next step?

A 48-year-old with early satiety and weight loss; EGD shows a 4-cm proximal gastric mass, biopsy GIST (KIT+). Preferred local treatment?

High-risk features after GIST resection (size >5 cm, high mitoses). Adjuvant therapy?

Early gastric cancer (T1a) confined to mucosa, no ulceration, small size. Potential curative option?

Standard lymphadenectomy with gastrectomy for invasive gastric adenocarcinoma?

Diffuse-type gastric carcinoma with linitis plastica. Most appropriate resection?

A 60-year-old with refractory GERD and normal motility undergoes Nissen fundoplication. Early severe dysphagia—first evaluation?

Barrett’s with confirmed high-grade dysplasia. Recommended therapy?

Caustic ingestion with odynophagia. First 24-hour diagnostic step if stable?

A 72-year-old with upper GI bleeding from gastric Dieulafoy lesion. Initial hemostasis method?

Post-esophagectomy day 5 patient spikes fever and tachycardia. Best test for suspected anastomotic leak?

Nutritional strategy after total gastrectomy to prevent dumping/anemia?

Classic triad of gastric volvulus?

Indication for surgery in peptic ulcer disease without complications?

Best operation for distal gastric cancer (antral) without duodenal invasion and adequate margins feasible?

A 58-year-old with progressive dysphagia; biopsy shows squamous cell carcinoma mid-esophagus. Risk factor most associated?

Indication to add pyloroplasty during truncal vagotomy for ulcer surgery?

Most accurate study to detect occult small-volume upper GI bleed after nondiagnostic EGD in stable patient?

Best treatment for refractory Schatzki ring causing intermittent solid-food dysphagia?

Sleeve gastrectomy patient has persistent severe reflux unresponsive to PPIs. Next operative step?

Early satiety, nausea, and retained food on EGD months after vagal injury. Diagnosis and initial therapy?

A 49-year-old with dyspepsia has 2-cm low-grade gastric NET (type I) associated with autoimmune atrophic gastritis. Management?

A 36-year-old with chest pain and dysphagia has high-resolution manometry showing hypercontractile (“jackhammer”) esophagus. First-line therapy?

A 58-year-old has intermittent chest pain and dysphagia; barium shows “corkscrew” esophagus. Best initial treatment?

A 29-year-old with food impactions and rings/furrows on EGD; biopsies show ≥15 eosinophils/hpf. Best management?

A 64-year-old with Barrett’s esophagus has confirmed low-grade dysplasia on repeat expert pathology. Preferred therapy?

Barrett’s “indefinite for dysplasia” during active esophagitis. Best next step?

A 72-year-old with iron-deficiency anemia and large hiatal hernia has linear gastric erosions at the diaphragmatic hiatus. Diagnosis?

A 55-year-old with H. pylori–positive gastric MALT lymphoma (localized) is hemodynamically stable. Best initial therapy?

A 50-year-old with isolated gastric varices from splenic vein thrombosis after pancreatitis has recurrent bleeding despite endoscopic therapy. Definitive treatment?

A patient with portal hypertensive gastropathy has recurrent bleeding. Preventive strategy?

A 61-year-old with refractory regurgitation and large paraesophageal hernia undergoes repair. Intra-op the GE junction cannot be reduced below the hiatus without tension. Next step?

Preoperative workup before antireflux surgery in a patient with typical GERD symptoms despite PPI should include:

Mandatory preoperative test to select the type of fundoplication?

A 45-year-old develops severe bloating and inability to belch after Nissen fundoplication. Initial management?

A patient with malignant dysphagia from unresectable distal esophageal cancer. Palliative option to restore swallowing?

Siewert type III gastroesophageal junction tumor is best managed surgically by:

Early gastric cancer with T1a, well-differentiated, nonulcerated, ≤2 cm. Curative local option?

A 48-year-old with gastric outlet obstruction from unresectable pancreatic cancer. Best palliation for poor surgical candidate?

A 64-year-old after Billroth II years ago has severe bile reflux gastritis refractory to medical therapy. Surgical solution?

Post-esophagectomy day 10, patient has dysphagia and inability to tolerate liquids; CT shows no leak. Likely cause and therapy?

A 33-year-old presents with early satiety; CT shows a large gastric phytobezoar. Initial management?

Achalasia type III (spastic) confirmed on manometry. Which treatment provides highest success?

After POEM for achalasia, patient develops new reflux. Best management?

A 70-year-old with H. pylori ulcer bleed treated endoscopically asks about test of cure. Correct timing?

A 58-year-old has recurrent bleeding duodenal ulcer despite two endoscopic hemostasis attempts. Next step?

A 47-year-old with massive hematemesis is found to have an actively spurting gastric ulcer (Forrest Ia). Appropriate endoscopic therapy?

A 63-year-old with persistent dysphagia after Heller myotomy has recurrent reflux and wrap failure. Next diagnostic test?

A 59-year-old with contained cervical esophageal perforation from iatrogenic injury, stable and nontoxic. Management?

A 27-year-old with symptomatic Zenker diverticulum 2.5 cm. Preferred approach?

A 52-year-old with acute variceal bleeding is stabilized. Best endoscopic therapy?

A 60-year-old with gastric adenocarcinoma of the antrum undergoes distal gastrectomy. Minimal nodal dissection standard in expert centers?

A 46-year-old with RYGB presents with choledocholithiasis. Preferred biliary access?

A 40-year-old post-RYGB has intermittent colicky pain; CT shows mesenteric swirl sign. Best step?

A 37-year-old with adjustable gastric band has progressive dysphagia and reflux; X-ray shows band slippage with pouch dilation. Management?

A 59-year-old with gastric polyp found incidentally: 6 mm fundic gland polyp, sporadic, on PPI. Best approach?

A 35-year-old with long-standing celiac disease has persistent dyspepsia; EGD reveals multiple small gastric polyps consistent with hyperplastic type. Next step?

A 68-year-old with advanced unresectable distal esophageal cancer and tracheoesophageal fistula develops aspiration. Palliative step?

A 54-year-old with suspected aortoenteric fistula after prior AAA repair presents with sentinel hematemesis and sepsis. Best immediate management?

A 66-year-old with recurrent solid-food dysphagia after Schatzki ring dilation. Strategy to reduce recurrence?

A 71-year-old with rebleeding gastric ulcer (Forrest IIa visible vessel) after initial epinephrine injection alone. Best next step?

A 62-year-old 15 years after partial gastrectomy develops weight loss and epigastric pain; EGD shows carcinoma at the anastomosis. Risk factor?

First-line eradication strategy in regions with high clarithromycin resistance for H. pylori?

After failing clarithromycin-based triple therapy for H. pylori, best salvage?

A 62-year-old with odynophagia and white plaques on EGD; HIV positive. Initial therapy?

Pill esophagitis from doxycycline is suspected. Key management step?

Long-standing caustic esophageal injury has which important long-term risk?

Scleroderma esophagus (aperistalsis, low LES). Best antireflux operation, if any?

Mallory–Weiss tear with ongoing bleeding despite initial epinephrine. Next step?

Workup before antireflux surgery shows normal manometry but pathologic acid exposure and large hernia. Best operation?

Post-fundoplication persistent dysphagia and gas-bloat at 6 months; esophagram shows tight wrap. Initial intervention?

Cameron lesions caused chronic anemia in a patient with giant hiatal hernia. After PPI/iron failure, definitive step?

For large hiatal hernia repair with fragile crura, which adjunct may reduce early recurrence?

Best staging approach for potentially resectable gastric adenocarcinoma (≥T2 or suspicious nodes) preoperatively?

Standard perioperative systemic therapy for resectable (≥T2/N+) gastric/GEJ cancer (non–HER2+) in fit patient?

Metastatic HER2-positive gastric/GEJ adenocarcinoma first-line systemic therapy?

Diffuse-type linitis plastica gastric cancer best resection?

Upper GI bleed resuscitation threshold for RBC transfusion in stable patients?

ESD for early gastric cancer complicated by delayed bleeding. Best management?

A patient with persistent dyspepsia has H. pylori–negative, NSAID-negative gastric ulcer. Next best step?

A 58-year-old with known cirrhosis presents with massive hematemesis and suspected esophageal varices. While arranging urgent endoscopy, which pharmacologic therapy should be started immediately?

In the same patient with acute variceal bleeding, which antibiotic strategy lowers infection, rebleeding, and mortality?

Variceal hemorrhage persists despite EVL and vasoactive drugs, with early rebleeding. Next best definitive step (no major contraindications)?

A patient with an adjustable gastric band develops chronic port infections, loss of restriction, and epigastric pain. Endoscopy shows intragastric band erosion. Best management?

A 45-year-old woman with dysphagia, iron-deficiency anemia, and a proximal esophageal web. Most appropriate initial therapy?

First-line eradication regimen for H. pylori in a patient with true penicillin allergy (high macrolide resistance region)?

After endoscopic submucosal dissection (ESD) of early gastric cancer, pathology shows deep submucosal invasion with lymphovascular invasion (noncurative resection). Optimal next step?

A patient months after distal gastrectomy with Roux-en-Y reconstruction has postprandial bloating, nausea, and delayed emptying without obstruction. Likely diagnosis and initial management?

Near-circumferential endoscopic ablation for Barrett’s leads to a symptomatic esophageal stricture. Best therapy?

A 63-year-old receiving chest radiotherapy develops odynophagia and retrosternal pain; EGD shows friable mucosa without infection. Preferred management?

A man with prior caustic alkali ingestion has long-standing esophageal strictures managed with periodic dilations. What long-term surveillance is appropriate?

A 39-year-old with a 3-cm submucosal mid-esophageal mass causing dysphagia; EUS shows homogeneous hypoechoic lesion from the muscularis propria, biopsy consistent with leiomyoma. Best treatment?