American Board of Internal Medicine (ABIM) Certification Practice Exam

What procedure should be performed after a negative upper endoscopy and colonoscopy?

1. Colorectal resection

2. Enteroscopy

3. Magnetic resonance imaging

4. Repeat the endoscopies

The correct answer is: Enteroscopy

Performing enteroscopy after a negative upper endoscopy and colonoscopy is a logical next step when there is a suspicion of small bowel pathology that has not been visualized by either of the upper or lower gastrointestinal tract evaluations. Upper endoscopy primarily examines the esophagus, stomach, and proximal duodenum, while colonoscopy allows for visualization of the colon and the distal ileum. However, these procedures do not include the entirety of the small intestine, which can harbor various conditions such as small bowel tumors, Crohn's disease, or other forms of enteropathy. Enteroscopy employs specialized techniques and equipment that allow for the evaluation of a greater segment of the small intestine, including the jejunum and ileum, which helps in diagnosing issues that were not detected in earlier examinations. This makes enteroscopy a suitable option for management when symptoms persist or when clinical suspicion remains high after both a negative upper endoscopy and colonoscopy. Other procedures mentioned might not target the underlying issues effectively. Colorectal resection is invasive and typically reserved for cases with significant findings such as cancer or severe structural lesions. Magnetic resonance imaging, while useful in certain contexts, does not provide direct visualization for intervention within the gastrointestinal tract. Repeating the endoscopies may not be productive