The Specialty certificate in Gastroenterology SCE covers the whole of the curriculum of the specialty training in gastroenterology in the UK. Preparation for this exam requires a wide breadth of knowledge around the curriculum . As knowledge is constantly advancing , awareness of current and updated guidelines is important.This blog is an attempt to pool all resources in one site with regular updates.
Dr Elmuhtady Said
Curriculum for Specialty Certificate Examination in Gastroenterology
A 56-year-old man undergoes an EGD for longstanding reflux. A subepithelial lesion is seen in the gastric body. Endoscopic ultrasound is performed and a well-defined, hypoechoic mass is seen. The transition zone is identified with the muscularis propria of the stomach. The mass measures 3.2cm and has irregular outer borders. There is an anechoic area within the lesion measuring 8mm suspicious for a cystic component. Core biopsy is obtained and it reveals spindle cells, c-kit positive. What is the appropriate management strategy for this patient?
A. Surveillance with endoscopic ultrasound
B. Surgical excision
C. Endoscopic mucosal resection
D. Fiducial placement under endoscopic ultrasound guidance for radiation therapy
Correct answer B Explanation
This lesion is consistent with a gastrointestinal stromal tumor with high risk features on endoscopic ultrasound (size greater than 2 cm, irregular border and cystic degeneration), therefore surgical excision is the best treatment option in this young patient. For smaller lesions, typically less than 2cm, surveillance is a reasonable option because of the low likelihood of malignant potential. Endoscopic mucosal resection should not be undertaken in this case given that it arises from the muscularis propria (4th layer) and risk of perforation is high. Radiation therapy for this lesion is not appropriate.
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A 56-year-old man undergoes an EGD for longstanding reflux. A subepithelial lesion is seen in the gastric body. Endoscopic ultrasound is performed and a well-defined, hypoechoic mass is seen. The transition zone is identified with the muscularis propria of the stomach. The mass measures 3.2cm and has irregular outer borders. There is an anechoic area within the lesion measuring 8mm suspicious for a cystic component. Core biopsy is obtained and it reveals spindle cells, c-kit positive. What is the appropriate management strategy for this patient?
ReplyDeleteA. Surveillance with endoscopic ultrasound
B. Surgical excision
C. Endoscopic mucosal resection
D. Fiducial placement under endoscopic ultrasound guidance for radiation therapy
Correct answer B
Explanation
This lesion is consistent with a gastrointestinal stromal tumor with high risk features on endoscopic ultrasound (size greater than 2 cm, irregular border and cystic degeneration), therefore surgical excision is the best treatment option in this young patient. For smaller lesions, typically less than 2cm, surveillance is a reasonable option because of the low likelihood of malignant potential. Endoscopic mucosal resection should not be undertaken in this case given that it arises from the muscularis propria (4th layer) and risk of perforation is high. Radiation therapy for this lesion is not appropriate.
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ReplyDeleteI was diagnosed as HEPATITIS B carrier in 2013 with fibrosis of the
ReplyDeleteliver already present. I started on antiviral medications which
reduced the viral load initially. After a couple of years the virus
became resistant. I started on HEPATITIS B Herbal treatment from
ULTIMATE LIFE CLINIC (www.ultimatelifeclinic.com) in March, 2020. Their
treatment totally reversed the virus. I did another blood test after
the 6 months long treatment and tested negative to the virus. Amazing
treatment! This treatment is a breakthrough for all HBV carriers.