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CME QUESTIONS

Continuing Medical Education Questions: April 2022

Patnana, Srikrishna V. MD

Author Information
The American Journal of Gastroenterology: April 2022 - Volume 117 - Issue 4 - p 541
doi: 10.14309/ajg.0000000000001718
  • Free

Abstract

LEARNING OBJECTIVE

After this activity, the participant will be able to diagnose and manage Barrett’s esophagus.

QUESTION 1

A 65-year-old man with obesity and well-controlled chronic gastroesophageal reflux disease (GERD) on once daily omeprazole 20 mg undergoes an upper endoscopy for Barrett’s esophagus screening. He is found to have a segment of salmon-colored mucosa consistent with Prague C3M5 classification. This is biopsied per the Seattle protocol. Additionally, a 7 mm nodule is removed by endoscopic mucosal resection (EMR). The esophageal biopsies show high-grade dysplasia (HGD). EMR histopathology shows intramucosal cancer (IMC). Both are confirmed by 2 GI pathologists.

What is the best next step in managing this patient’s Barrett’s esophagus?

  • A. Increase omeprazole to 20 mg twice daily
  • B. Recommend endoscopic eradication therapy (EET) of HGD.
  • C. Recommend esophagectomy because of the intramucosal cancer
  • D. Repeat upper endoscopy in 3 months for surveillance of the HGD.

QUESTION 2

A 70-year-old woman has chronic GERD which is well controlled with 30 mg lansoprazole once daily. Upper endoscopy showed a 5 cm segment of Barrett’s esophagus with low-grade dysplasia (LGD), confirmed by 2 GI pathologists. Her comorbidities included well-controlled hypertension and diabetes mellitus. You recommend endoscopic eradication therapy (EET), but the patient is worried about complications of EET.

What would you tell the patient is the most common adverse event of first line EET for Barrett’s esophagus?

  • A. Major GI bleeding
  • B. Esophageal perforation
  • C. Disease progression
  • D. Esophageal stricture

QUESTION 3

Based on this article, which of the following scenarios constitutes a definitive diagnosis of Barrett’s esophagus?

  • A. Irregular squamocolumnar junction with biopsies showing columnar epithelium
  • B. A 1-cm tongue of salmon-colored mucosa with biopsies showing squamous epithelium
  • C. A 2-cm tongue of salmon-colored mucosa with biopsies showing columnar epithelium and goblet cells
  • D. A 1-cm tongue of salmon-colored mucosa with biopsies showing columnar epithelium

© 2022 by The American College of Gastroenterology