ROSH Gastrointestinal Practice Exam

For a man with vague abdominal pain and unintentional weight loss, which diagnostic study is most likely to provide a definitive diagnosis?

1. Contrast-enhanced CT scan of abdomen and pelvis

2. Double-contrast radiography

3. Endoscopic sonography

4. Esophagogastroduodenoscopy

The correct answer is: Esophagogastroduodenoscopy

In the context of a man presenting with vague abdominal pain and unintentional weight loss, a definitive diagnosis often hinges on identifying possible gastrointestinal conditions, which may include malignancies or structural abnormalities. Esophagogastroduodenoscopy (EGD) is particularly suitable because it allows for direct visualization of the esophagus, stomach, and the duodenum. This procedure not only helps identify any mucosal lesions, strictures, or tumors but also enables biopsy of suspicious areas for histopathological examination, which is crucial in diagnosing conditions like cancer or peptic ulcers. While other diagnostic methods are valuable, they may not provide the same level of direct access or opportunity for biopsy as EGD does. For instance, although a contrast-enhanced CT scan is excellent for evaluating complex abdominal pathology and may show abnormalities related to malignancies, it does not allow for tissue sampling. Double-contrast radiography helps visualize the upper gastrointestinal tract but is less sensitive in detecting subtle mucosal lesions compared to EGD. Endoscopic sonography can be beneficial, particularly in looking at submucosal lesions and surrounding structures, but it is not as definitive for mucosal pathology like cancer or ulcers as EGD. Thus, EGD stands out as the best choice for this