FES WRITTEN EXAM
• Time frames for upper endoscopy - Familiar polyposis
ANSWER 1-2 years
• Patient positioning for ERCP ANSWER prone position
with the head turn toward the right shoulder
• patient positioning for upper endoscopy ANSWER left side
down, head slightly up.
• Maneuver to look at the GE junction ANSWER 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 ANSWER
selective bile duct cannulation w/ guidewire, stenting
,pancreatic dut w/ stent or guidewire for diflcult CBD
cannulation, limiting contrast injection into the pancreatic
duct
• Technique for billiary sphincterotomy ANSWER 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 ANSWER can use balloon dilation but a/w higher rate
of post-ECRP pancreatitis
• Direction of pancreatic cannulation during ERCP ANSWER
1 to 3 o'clock position
• When to stop warfarin before ERCP ANSWER 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 ANSWER 3-5%
, • Timing of colonoscopy for first degree relative w/ CRC or
adenomas prior to age 60 ANSWER colonoscopy at age 40
or 10 years before the youngest attected relative, whichever
is earlier. Then repeat every 5 yrs
• Indications for ECRP ANSWER Tissue
sampling - bile duct, pancreatic duct,
ampulla bx chronic
pancreatitis/divisumpancreatic malignancy
billiary malignancy Benign stricturesDuctal
disruption/injury Jaundice
cholangitis gallstone pancreatitis dilated CBD
• maneuvers to enter IC valve ANSWER rotate the scope
until the valve is at the bottom of the visual field, look
down into the valve, gently insufflate 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 ANSWER 20-60%
• Time frames for upper endoscopy - Familiar polyposis
ANSWER 1-2 years
• Patient positioning for ERCP ANSWER prone position
with the head turn toward the right shoulder
• patient positioning for upper endoscopy ANSWER left side
down, head slightly up.
• Maneuver to look at the GE junction ANSWER 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 ANSWER
selective bile duct cannulation w/ guidewire, stenting
,pancreatic dut w/ stent or guidewire for diflcult CBD
cannulation, limiting contrast injection into the pancreatic
duct
• Technique for billiary sphincterotomy ANSWER 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 ANSWER can use balloon dilation but a/w higher rate
of post-ECRP pancreatitis
• Direction of pancreatic cannulation during ERCP ANSWER
1 to 3 o'clock position
• When to stop warfarin before ERCP ANSWER 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 ANSWER 3-5%
, • Timing of colonoscopy for first degree relative w/ CRC or
adenomas prior to age 60 ANSWER colonoscopy at age 40
or 10 years before the youngest attected relative, whichever
is earlier. Then repeat every 5 yrs
• Indications for ECRP ANSWER Tissue
sampling - bile duct, pancreatic duct,
ampulla bx chronic
pancreatitis/divisumpancreatic malignancy
billiary malignancy Benign stricturesDuctal
disruption/injury Jaundice
cholangitis gallstone pancreatitis dilated CBD
• maneuvers to enter IC valve ANSWER rotate the scope
until the valve is at the bottom of the visual field, look
down into the valve, gently insufflate 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 ANSWER 20-60%
