Common misconception: APC only causes superficial damage. Per the authors, persistent APC on one spot can cause carbonization, deep tissue injury, even perforation. Apply it dynamically. By Adil Mir, MD, Reid Wasserman, DO and Klaus Mönkemüller, MD, PhD

Ischemic colitis: rectal sparing, segmental left colon disease, and a linear ulcer on the mesenteric border (Zuckerman's sign). Case by Klaus Mönkemüller, MD, PhD.

Extensive esophageal necrosis 6 hours after sodium hydroxide ingestion. Scope stopped at the EGJ because of perforation risk. Case by Klaus Mönkemüller, MD, PhD.

Barrett's with varices. 50-year-old patient sent for Barrett's esophagus and esophageal varices. Band ligation of the Barrett's segment obliterates the varices and eradicates the Barrett's mucosa. Case by Hiral Patel, MD and Klaus Mönkemüller, MD, PhD.

Cirrhosis, hematemesis and melena for one day. EGD shows this varix. Which sign is it? A) Red spots B) Red wale sign C) Nipple sign D) Active bleeding The case, and why the authors banded quickly, by Rami Musallam, MD and Klaus Mönkemüller, MD, PhD:

The snare keeps slipping off a flat lesion. Pre-cutting EMR (hybrid ESD-EMR) in 3 steps: 1. Inject a submucosal cushion 2. Incise around the lesion with the snare tip (usually 1-2 mm exposure) 3. Snare in the groove and resect Full technique by Klaus Mönkemüller, MD, PhD:

Find the bleeding source. Duodenum case: recurrent overt GI bleeding, and two previous EGDs without significant findings. On the third look: active bleeding, no ulceration or angiodysplasia. Hemostasis with a through-the-scope clip. Full case by Klaus Mönkemüller, MD, PhD:

A careful gastric examination is essential even when the indication is reflux. Any focal change in contour, color, or surface texture deserves closer examination.

Guess the diagnosis: esophagus case with cottage-cheese plaques. 68yo with diabetes, dysphagia for 1 week. What do you see? Drop your guess below, then see the full case (EGD + brushings + treatment): thepracticingendoscopist.com… By Klaus Mönkemüller, MD, PhD.

A 2 cm gastric lesion, found on an EGD for reflux. Neither a bland color nor a smoothly lobulated contour reliably establishes the benign nature of the lesion.

Pedunculated polyp: clip the stalk before you snare? The authors' preferred approach: hemostasis first. In this case, two clips, then hot snare above. By Diana L. Dougherty, MD, MPH, and Klaus Mönkemüller, MD, PhD. thepracticingendoscopist.com…

Patient on Eliquis. Large pedunculated polyp. There is always a feeding vessel in the stalk. Clip the stalk, then snare. Case by Klaus Mönkemüller, MD, PhD. AI-narrated. thepracticingendoscopist.com…

No coils, no hemostatic powder, no over-the-scope clip. So no endoscopic closure. A transcatheter coil pack occluded the portal vein pseudoaneurysm. Follow-up CT: complete resolution.

The orifice was a portal vein-duodenal fistula. A portal vein pseudoaneurysm had ruptured into the bulb. Endoscopy found the hole. CT confirmed the pseudoaneurysm.

Large gastric ulcers after Y-90 radioembolization. Fundus and proximal body. Fibrin on the base, two visible vessels, and no active bleeding.

57-year-old man, massive hematemesis. Lap cholecystectomy, then laparotomy for perforated appendicitis 10 days later. After clot evacuation, this orifice sat in the duodenal bulb. What is it? Reply with your answer.

60-year-old man on Eliquis, stopped 2 days before colonoscopy. Large pedunculated polyp in the sigmoid colon. How would you resect it? 10 options in the last image. Reply with your letter.

Plummer-Vinson syndrome on one sheet: the triad, the dilation, and why surveillance is lifelong. Upper esophageal stenosis in a 78-year-old woman with chronic iron deficiency anemia.

Smooth extrinsic pinch of the bile duct. No stone in the lumen. This is pseudo-Mirizzi. Surgery found an obliterated Calot triangle.

Three clues to a bigger vessel in the stalk: a large head, advanced adenomatous features, and a thick stalk. Cutting first can bleed briskly, especially on anticoagulation.