FES WRITTEN COMPREHENSIVE EXAM 2026
FULL QUESTIONS AND ANSWERS GRADED A+
● 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 difficult 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: 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 affected relative, whichever is earlier. Then repeat every 5 yrs
● Indications for ECRP . Answer: 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 . 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%
● band ligation vs sclerotherapy for esophageal varices . Answer: equal
efficacy but baldn ligation has lower complication rate.
● cancer detection rate of needle aspiration . Answer: 6-30%
● how long after sphincterotomy can the bleeding complication
manifest? . Answer: immediate up to 14 days
● relative contraindications for colonoscopy . Answer: anal fissure,
recent MI, PE, large bowel obstruction
● Time frames for upper endoscopy - esophageal varices s/p
sclerotherapy and banding . Answer: q6-8weeks
FULL QUESTIONS AND ANSWERS GRADED A+
● 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 difficult 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: 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 affected relative, whichever is earlier. Then repeat every 5 yrs
● Indications for ECRP . Answer: 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 . 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%
● band ligation vs sclerotherapy for esophageal varices . Answer: equal
efficacy but baldn ligation has lower complication rate.
● cancer detection rate of needle aspiration . Answer: 6-30%
● how long after sphincterotomy can the bleeding complication
manifest? . Answer: immediate up to 14 days
● relative contraindications for colonoscopy . Answer: anal fissure,
recent MI, PE, large bowel obstruction
● Time frames for upper endoscopy - esophageal varices s/p
sclerotherapy and banding . Answer: q6-8weeks
