FES COMPREHENSIVE EXAM PREP
QUESTIONS AND ANSWERS STUDY GUIDE
●● 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%
QUESTIONS AND ANSWERS STUDY GUIDE
●● 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%
