Esophagus and Stomach Surgery (GERD, Carcinoma Stomach, Peptic Ulcer) MCQs

Surgery · 119 free questions with answers & explanations.

A 60-year-old man with longstanding GORD undergoes upper GI endoscopy that shows replacement of the normal squamous epithelium in the distal oesophagus with salmon-pink metaplastic columnar epithelium confirmed as intestinal metaplasia on biopsy. This finding is:
A 58-year-old man presents with early satiety, anorexia, and weight loss. Endoscopy reveals a linitis plastica appearance — rigid, non-distensible stomach. Biopsy confirms signet-ring cell gastric adenocarcinoma. Which lymph node group is the sentinel indicator of unresectability in gastric cancer?
A 60-year-old patient with gastric adenocarcinoma on CT has a mass in the distal stomach with a single regional lymph node enlarged at 1.5 cm, no distant metastasis. EUS confirms T3 N1 M0 staging. As per current guidelines, the optimal pre-operative strategy is:
A patient presents with hematemesis and melena. Urgent endoscopy reveals a duodenal ulcer with active spurting arterial bleeding (Forrest grade Ia). Endoscopic hemostasis is achieved with dual therapy. Which vessel is most commonly responsible for significant bleeding from a posterior duodenal ulcer?
A 55-year-old man with a long history of GORD undergoes surveillance OGD showing circumferential salmon-coloured mucosa from 32 to 38 cm from the incisors. Biopsy shows intestinal metaplasia with specialised columnar epithelium. High-grade dysplasia is found in 2 biopsies. The current recommended treatment for Barrett's oesophagus with high-grade dysplasia is:
Regarding carcinoma of the stomach, the Lauren classification divides gastric cancer into intestinal and diffuse types. Which statement correctly differentiates the two types regarding epidemiology, pathology, and prognosis?
A 50-year-old man undergoes Billroth II (gastrojejunostomy) for peptic ulcer disease. Three months later he develops episodic symptoms of sweating, palpitations, weakness, and diarrhoea occurring 1–3 hours after meals. The blood glucose at the time of symptoms is 52 mg/dL. This is best classified as:
A 58-year-old man with stage III gastric adenocarcinoma of the gastric antrum (T3 N2 M0) is planned for surgery. The FLOT-4 trial changed the standard perioperative chemotherapy regimen. According to FLOT-4 results, which regimen offers superior overall survival compared to the earlier ECF/ECX (epirubicin-cisplatin-fluorouracil) perioperative regimen?
A 48-year-old man with known Barrett's oesophagus (long-segment, 6 cm) undergoes surveillance endoscopy. Biopsies from a nodular area confirm intramucosal adenocarcinoma (T1a, no submucosal invasion, no lymphovascular invasion). The most appropriate management is:
The Siewert classification of gastroesophageal junction (GEJ) adenocarcinomas guides the surgical approach. A tumor centered 3 cm below the GEJ in the cardia is classified as which Siewert type, and what is the recommended operation?
A 55-year-old man with gastric cancer (cT3N1M0, intestinal type, antrum) is planned for curative resection. According to the FLOT4 trial, which perioperative chemotherapy regimen has been shown to improve overall survival compared to ECF/ECX?
A 50-year-old woman with known duodenal ulcer presents with sudden onset severe epigastric pain that became generalized. Erect chest X-ray shows free air under the diaphragm. After initial resuscitation, surgery reveals a 1 cm perforation on the anterior wall of the first part of the duodenum with peritoneal soiling. What is the most appropriate surgical management?
A patient with Barrett's oesophagus undergoes endoscopic surveillance. Biopsies from a flat segment reveal high-grade dysplasia (HGD) without a visible lesion. According to current BSG/ESGE guidelines, what is the most appropriate management?
In Siewert classification of oesophagogastric junction (OGJ) tumours, a Type II tumour (true cardia carcinoma, epicentre 1 cm above to 2 cm below the OGJ) is surgically managed by which approach?
Following a highly selective vagotomy (proximal gastric vagotomy/HSV), what is the physiological mechanism by which basal acid output is reduced without affecting antral motility and pyloric function?
A 55-year-old patient with adenocarcinoma of the gastroesophageal junction (Siewert Type II) undergoes staging. CT shows perigastric lymph node involvement but no distant metastases (cT3N1M0). The FLOT4-AIO trial established which perioperative chemotherapy regimen as superior to ECF/ECX for resectable gastric/GEJ adenocarcinoma?
Siewert classification categorizes adenocarcinomas of the gastroesophageal junction. A tumor centered 3 cm above the anatomical cardia (Z-line) is classified as:
A 45-year-old man with duodenal ulcer and H. pylori infection undergoes eradication therapy. One month after completing triple therapy, urea breath test remains positive. The most appropriate next step is:
The CROSS trial established the role of neoadjuvant treatment for resectable esophageal and gastroesophageal junction (GEJ) cancer. Which treatment regimen was used, and what were its key benefits?
A patient with gastric adenocarcinoma at the cardia (Siewert type II) undergoes total gastrectomy. According to the FLOT4-AIO trial, which perioperative chemotherapy regimen showed superior overall survival compared to ECF/ECX regimen?
During laparoscopic Nissen fundoplication for GERD, which intraoperative maneuver is CRITICAL to prevent post-operative dysphagia from an overly tight wrap?
A 62-year-old man with a T3N2M0 gastric adenocarcinoma of the antrum has undergone perioperative FLOT chemotherapy (3 cycles). He is now fit for surgery. The tumour involves the D1 nodes. According to FLOT4 trial and D2 gastrectomy evidence, which surgical approach optimises oncological outcome?
A 55-year-old man with Siewert type II adenocarcinoma of the oesophagogastric junction (OGJ) is found on staging to have T3N1M0. What defines Siewert type II and what is its recommended surgical approach?
A 55-year-old man with biopsy-proven Barrett's esophagus with high-grade dysplasia (HGD) is evaluated. He is fit for endoscopy. According to ACG and BSG 2022 guidelines, the preferred treatment is:
A 60-year-old patient with locally advanced gastric cancer (cT3N2M0) is planned for perioperative chemotherapy. The FLOT4-AIO trial demonstrated superiority of which regimen over ECF/ECX for perioperative chemotherapy?
A 60-year-old patient with T3N2M0 gastric adenocarcinoma (signet ring cell type) at the gastroesophageal junction (Siewert Type III) is being considered for surgery. The FLOT4-AIO trial changed gastric cancer perioperative chemotherapy. Which regimen does FLOT4 support as superior to MAGIC (ECF/ECX)?
A 45-year-old man with a chronic duodenal ulcer requires surgical treatment after failed H. pylori eradication and refractory symptoms. He has no evidence of malignancy. The preferred elective surgical procedure for duodenal ulcer disease is a truncal vagotomy combined with which drainage procedure, and why?
A 58-year-old man with a long history of GORD undergoes endoscopy showing 6 cm circumferential salmon-pink mucosa replacing the squamo-columnar junction, confirmed as specialised intestinal metaplasia with high-grade dysplasia (HGD) on biopsy. According to current ACG/BSG guidelines, the preferred management for Barrett's oesophagus with HGD is:
A 55-year-old man with Barrett's esophagus undergoes surveillance endoscopy. Biopsies show high-grade dysplasia (HGD). According to current BSG/ACG guidelines, the preferred management is:
According to the Japanese Classification of Gastric Carcinoma (JCGC), a D2 lymphadenectomy for a resectable gastric cancer of the mid-body (corpus) includes removal of which nodal stations that are NOT included in a D1 dissection?
In the Nissen fundoplication for GERD, what is the most common long-term complication leading to reoperation?
A 62-year-old man undergoes total gastrectomy with D2 lymphadenectomy for gastric carcinoma (pT3N2M0, 7 of 22 nodes involved). Post-operative adjuvant treatment per the FLOT4-AIO trial paradigm (European approach) involves which perioperative regimen?
A 45-year-old woman with long-segment Barrett's esophagus (8 cm) develops high-grade dysplasia confirmed by two expert pathologists. What is the current recommended management per BSG/AGA guidelines?
A 55-year-old man with refractory peptic ulcer disease is found to have Zollinger-Ellison syndrome (ZES). Sestamibi scan and CT fail to localize the gastrinoma. What is the best next localizing investigation?
A 55-year-old male with H. pylori-negative peptic ulcer disease refractory to proton pump inhibitors has a fasting serum gastrin of 1200 pg/mL (normal < 110 pg/mL). Secretin stimulation test shows a paradoxical rise in gastrin. Which classification describes the site of gastrinoma in 80% of cases?
A 62-year-old patient with linitis plastica on CT (diffuse gastric wall thickening, absence of peristalsis) and signet-ring cell adenocarcinoma on biopsy undergoes laparoscopic staging. Diagnostic laparoscopy reveals peritoneal nodules. Which scoring system uses peritoneal cancer index (PCI) and has been used to select patients for cytoreductive surgery + HIPEC in gastric cancer with peritoneal metastasis?
Post-gastrectomy, a patient develops symptoms of early dumping syndrome: flushing, palpitations, diarrhea, and syncope 15–30 minutes after eating. What is the pathophysiological mechanism responsible for these symptoms?
A 60-year-old man with cT3N2M0 gastric cancer at the gastro-oesophageal junction (Siewert type III) is being planned for resection. Based on the FLOT4-AIO trial (Al-Batran et al., Lancet 2019), which perioperative chemotherapy regimen has shown superior overall survival over ECF/ECX?
A patient with Zollinger-Ellison syndrome (ZES) is referred for surgical evaluation. Secretin stimulation test shows a paradoxical rise in serum gastrin >200 pg/mL. Imaging shows a 1.2 cm lesion in the duodenal wall (first part). The relevant surgical anatomy dictates that most sporadic gastrinomas are located within the 'gastrinoma triangle.' Which anatomical boundaries define this triangle?
A 55-year-old man develops a Roux-en-Y gastric bypass-related complication presenting as episodic postprandial cramping, diarrhoea, flushing, and palpitations occurring 30 minutes after eating. Blood glucose during an episode is 45 mg/dL. This is best described as:
The MAGIC trial (Cunningham et al., NEJM 2006) established which chemotherapy regimen as standard perioperative treatment for resectable gastric/GEJ adenocarcinoma?
Manometry reveals failed peristalsis (≥50% of swallows with absent or failed peristalsis) with incomplete lower esophageal sphincter (LES) relaxation (median integrated relaxation pressure ≥15 mmHg). According to Chicago Classification v4.0, this pattern is best classified as:
A 45-year-old H. pylori-positive patient presents with a bleeding duodenal ulcer (Forrest Ia — spurting arterial hemorrhage) at endoscopy. After achieving hemostasis, what is the current evidence-based management of H. pylori?
The Siewert classification of adenocarcinoma at the gastroesophageal junction divides tumours based on their relationship to the anatomical GEJ. Type II (true cardia carcinoma) is defined as having its centre located:
Following Helicobacter pylori eradication, which combination constitutes first-line triple therapy in areas with clarithromycin resistance <15%, and what is the recommended duration per current ACG/ESGE guidelines?
In the FLOT4 trial for locally advanced gastric and GEJ adenocarcinoma, perioperative FLOT chemotherapy was compared to ECF/ECX. The primary finding that changed the standard of care was:
The FLOT4 trial changed the perioperative chemotherapy regimen for resectable gastric and gastroesophageal junction adenocarcinoma. Which regimen did FLOT replace as the new standard?
In the Siewert classification of gastroesophageal junction (GEJ) adenocarcinoma, a type II tumor has its epicenter located within which anatomical boundary?
A 50-year-old woman presents with refractory GERD and 5 cm hiatus hernia. High-resolution manometry shows hypotensive LES (4 mmHg) with 95% ineffective esophageal motility. Which finding on preoperative workup would most influence the surgical approach to antireflux surgery?
A 58-year-old man with a 10-year history of GERD undergoes surveillance upper endoscopy. Biopsy shows high-grade dysplasia (HGD) in Barrett's oesophagus (segment length 5 cm). CT chest/abdomen is negative for invasion or nodes. What is the current recommended management?
A 62-year-old man undergoes staging for gastric adenocarcinoma and is found to have a T3 N2 M0 tumour of the gastric body with signet ring cell histology. ECOG performance status is 1. HER2 is negative. The standard of care treatment is:
A 35-year-old woman presents with a perforated duodenal ulcer. Intraoperative findings show a 1 cm anterior first-part duodenum perforation with faecal-free pneumoperitoneum of 6 hours duration. She is haemodynamically stable. The most appropriate definitive surgical procedure is:
A 55-year-old man presents with progressive dysphagia and weight loss. OGD reveals a malignant-looking stricture in the lower oesophagus. Biopsy confirms adenocarcinoma. PET-CT staging shows no distant metastases, and staging laparoscopy is negative. EUS shows T3N1. According to the FLOT protocol (FLOT4-AIO trial), the perioperative chemotherapy regimen is:
A 45-year-old man with a peptic ulcer perforates and undergoes emergency laparotomy. A 1.5 cm anterior duodenal perforation is found and repaired with an omental patch (Graham's patch). Three weeks later he presents with early satiety and vomiting of undigested food. The MOST likely diagnosis is:
Barrett's oesophagus with high-grade dysplasia (HGD) is now most commonly treated by endoscopic eradication therapy (EET). Which combination represents the current standard endoscopic approach for HGD in Barrett's oesophagus?
In the operative management of achalasia, the Heller myotomy involves longitudinal division of the lower oesophageal circular muscle fibres. To prevent post-operative gastro-oesophageal reflux, Heller myotomy is routinely combined with which anti-reflux procedure?
The CROSS trial established perioperative treatment for resectable oesophageal cancer. Carboplatin/paclitaxel plus concurrent radiotherapy (41.4 Gy in 23 fractions) given neoadjuvantly followed by oesophagectomy versus surgery alone showed:
The FLOT4 trial compared perioperative FLOT (docetaxel, oxaliplatin, leucovorin, 5-FU) versus perioperative ECF/ECX (epirubicin, cisplatin, 5-FU/capecitabine) for resectable gastric and gastro-oesophageal junction adenocarcinoma. The primary outcome showed FLOT had:
The Lauren classification of gastric carcinoma has prognostic and surgical implications. Which of the following correctly pairs the histological type with its characteristic spread pattern?
A 62-year-old man is diagnosed with esophageal adenocarcinoma at the gastroesophageal junction (Siewert type II). Staging CT and PET show no metastasis, and endoscopic ultrasound confirms T3N1. According to current evidence, what is the preferred neoadjuvant treatment?
A 45-year-old woman presents with epigastric pain, dyspepsia, and melena. OGD shows a gastric ulcer with a Forrest classification of Ia. Which Forrest class does this represent and what is the recommended management?
A 58-year-old man with gastric adenocarcinoma of the antrum is found to have peritoneal deposits at staging laparoscopy. The primary tumor is unresectable. According to the ToGA trial, which treatment combination showed improved survival in HER2-positive gastric/GEJ adenocarcinoma?
A 55-year-old man with Barrett's esophagus undergoes endoscopic surveillance. Biopsy confirms high-grade dysplasia (HGD) with no visible lesion and no endoscopic evidence of adenocarcinoma. What is the most appropriate management according to current guidelines?
A patient undergoes laparoscopic Nissen fundoplication for refractory GERD. Two years later, she presents with progressive dysphagia to solids and liquids, regurgitation, and inability to belch. Barium swallow shows a bird's beak appearance of the distal esophagus. What complication has occurred?
The FLOT (Fluorouracil, Leucovorin, Oxaliplatin, Docetaxel) protocol for gastric cancer became a standard perioperative regimen based on the FLOT4 trial. FLOT was compared to which older regimen in this trial?
Barrett's esophagus with low-grade dysplasia confirmed by two expert pathologists: the most appropriate initial management according to British Society of Gastroenterology guidelines is:
A 55-year-old man undergoes emergency laparotomy for perforated peptic ulcer. A 1 cm perforation is found at the anterior wall of the first part of the duodenum. H. pylori testing is positive. The most appropriate surgical treatment at this emergency is:
A 58-year-old man with diffuse-type gastric adenocarcinoma (signet-ring cells, linitis plastica) has no distant metastases on staging CT. HER2 is negative. Genomic profiling shows microsatellite instability-high (MSI-H). The most appropriate perioperative treatment strategy is:
A 50-year-old man presents with persistent dysphagia. Upper GI endoscopy shows a mid-esophageal mucosal irregularity. Biopsy shows Barrett's esophagus with high-grade dysplasia (HGD) over a 2 cm segment without any visible lesion. The first-line treatment is:
A 30-year-old man presents with an acute perforated duodenal ulcer. Omental patch repair (Graham patch) is performed. Postoperatively, what is the most important investigation before discharge?
The FLOT4 trial established FLOT (5-FU, leucovorin, oxaliplatin, docetaxel) as the preferred perioperative chemotherapy regimen for gastric and gastroesophageal junction adenocarcinoma over which earlier regimen?
In Nissen fundoplication for GERD, the wrap is constructed as a 360° fundoplication around the intraabdominal oesophagus over a calibration bougie of approximately:
A 55-year-old man undergoes emergency laparotomy for a perforated duodenal ulcer. The perforation is 8 mm in the anterior wall of the first part of the duodenum. The optimal surgical procedure is:
Barrett's oesophagus with low-grade dysplasia is confirmed on two separate biopsies reviewed by an expert GI pathologist. Current guidelines (BSG/ASGE) recommend:
The Lauren classification of gastric carcinoma divides tumours into intestinal and diffuse types. Which of the following statements correctly distinguishes the two types?
A 45-year-old man underwent truncal vagotomy and pyloroplasty for a perforated duodenal ulcer 10 years ago. He now presents with post-prandial bilious vomiting, abdominal fullness, and weight loss. Endoscopy shows food residue in the stomach. The MOST likely diagnosis is:
The DeMeester score is used in ambulatory 24-hour pH monitoring to evaluate GERD. A score above what value is considered abnormal?
The FLOT regimen is the current preferred perioperative chemotherapy for resectable gastric and gastroesophageal junction (GEJ) adenocarcinoma based on the FLOT4 trial. What are its components?
A patient with Zollinger-Ellison syndrome (ZES) due to a solitary gastrinoma has a serum gastrin of 850 pg/mL (normal <100). The secretin stimulation test shows an increase of >200 pg/mL above baseline. Imaging localizes a 1.5 cm duodenal wall tumor. What is the most appropriate management?
The Siewert classification of adenocarcinoma at the gastro-oesophageal junction (GOJ) determines surgical approach. A Siewert Type II tumour is centred at the cardia. Which surgical approach is MOST appropriate?
A patient with a perforated duodenal ulcer undergoes laparotomy. A 1 cm perforation is found in the anterior wall of the first part of duodenum. What is the preferred immediate surgical procedure?
Barrett's oesophagus with low-grade dysplasia on two separate endoscopic biopsies is identified in a 52-year-old man. According to current surveillance guidelines, what is the MOST appropriate management?
A 58-year-old man is found to have a 4 cm gastric cancer on CT staging (cT3N2M0, Lauren diffuse type). He undergoes FLOT (fluorouracil, leucovorin, oxaliplatin, docetaxel) perioperative chemotherapy per FLOT4 trial protocol. How many cycles are given preoperatively and postoperatively?
A 50-year-old man with Barrett's oesophagus undergoes endoscopic surveillance. Biopsy shows high-grade dysplasia (HGD) in a 2 cm segment. Which ablative modality has the highest efficacy and is the current preferred treatment?
A patient presents with haematemesis. OGD shows a gastric ulcer with a visible vessel in the ulcer base. After successful endoscopic haemostasis (adrenaline injection + heater probe), the patient re-bleeds 6 hours later. The next appropriate step is:
A 58-year-old man with a long history of GERD undergoes endoscopy showing circumferential salmon-pink mucosa extending 4 cm above the GOJ with goblet cells on biopsy. This confirms Barrett's oesophagus. The MOST important histological feature that upgrades surveillance intensity and mandates intervention is:
A 65-year-old man is found to have a gastric carcinoma of the antrum. EUS staging shows T3 N2 M0. CT shows no distant metastasis. The FLOT (fluorouracil, leucovorin, oxaliplatin, docetaxel) regimen is planned. According to the FLOT4-AIO trial, the use of perioperative FLOT compared to ECF/ECX demonstrated:
During Whipple's procedure (pancreaticoduodenectomy), the reconstruction involves a hepaticojejunostomy, pancreaticojejunostomy, and gastrojejunostomy in a specific sequence. The most common and most serious early complication of the Whipple procedure is:
In the Siewert classification of adenocarcinoma of the oesophagogastric junction (OGJ), a tumour centred within 1–5 cm above the OGJ (anatomical OGJ = z-line) is classified as:
A patient with a perforated duodenal ulcer presents 6 hours after onset with peritonitis. At laparotomy, the perforation is 5 mm and the surrounding tissue is healthy. After peritoneal lavage and debridement, the most appropriate repair technique is:
A 55-year-old patient with Barrett's oesophagus on surveillance endoscopy is found to have low-grade dysplasia (LGD) confirmed on two separate endoscopies by two independent pathologists. According to the British Society of Gastroenterology guidelines, what is the recommended management?
A 60-year-old man with resectable gastric adenocarcinoma (T3N1M0) is being considered for perioperative chemotherapy. According to the FLOT4-AIO trial, which perioperative regimen showed superior overall survival compared to ECF/ECX?
A patient with a perforated duodenal ulcer undergoes omental patch repair (Graham patch). Post-operatively, which additional treatment must be initiated to reduce the risk of recurrent ulceration?
The FLOT4-AIO trial compared perioperative FLOT with perioperative ECF/ECX for resectable gastric and gastro-oesophageal junction adenocarcinoma. The primary endpoint result was:
A 58-year-old man with Barrett's oesophagus undergoes endoscopic surveillance. Biopsy shows high-grade dysplasia (HGD) without visible lesion. The recommended management per current guidelines is:
The Lauren classification of gastric carcinoma divides it into intestinal and diffuse types. Krukenberg tumour specifically arises from which type, and what is the route of spread?
Achalasia is characterised by failure of the lower oesophageal sphincter to relax and absent peristalsis. The Chicago Classification v4.0 of oesophageal motility disorders identifies three subtypes of achalasia based on high-resolution manometry (HRM). In Type II achalasia, the Chicago criteria require:
Zollinger-Ellison syndrome (ZES) is caused by a gastrinoma. The most sensitive biochemical test for confirming the diagnosis when fasting serum gastrin is borderline elevated (150–500 pg/mL) and gastric pH <2 is:
The Siewert classification of adenocarcinoma of the esophagogastric junction (EGJ) defines Type I, II, and III based on the relationship of the tumor center to the EGJ. Siewert Type II tumors originate within what distance from the EGJ?
In the MAGIC trial (Medical Research Council Adjuvant Gastric Infusional Chemotherapy), perioperative chemotherapy with ECF regimen significantly improved which outcome in resectable gastric and lower esophageal cancer?
Boerhaave syndrome (spontaneous esophageal perforation) most commonly occurs at which anatomical location and involves which mechanism?
Roux-en-Y gastric bypass (RYGB) achieves type 2 diabetes remission beyond caloric restriction through which mechanism that distinguishes it from purely restrictive procedures?
In Barrett's esophagus with confirmed high-grade dysplasia (HGD), the current recommended management according to British Society of Gastroenterology (BSG) guidelines is:
The FLOT4 trial established FLOT (5-FU + leucovorin + oxaliplatin + docetaxel) as superior to ECF/ECX for resectable gastric and gastro-oesophageal junction adenocarcinoma. The primary endpoint demonstrated improved:
In Barrett's oesophagus surveillance, the Prague C&M classification records two measurements. 'C3 M6' indicates:
After Billroth II gastrectomy, a patient develops bile vomiting relieved by food, bilious aspirates, and abdominal pain — worse in the morning. The most likely diagnosis is:
The FLOT4 trial published in 2019 changed the perioperative chemotherapy regimen for resectable gastric/gastro-oesophageal junction (GEJ) adenocarcinoma. Which of the following best summarises the findings?
Barrett's oesophagus with low-grade dysplasia (LGD) confirmed by two expert pathologists is best managed according to current BSG/ESGE guidelines by:
In oesophageal squamous cell carcinoma, which surgical approach (Ivor Lewis vs. McKeown vs. transhiatal) is considered to provide optimal oncological lymphadenectomy for mid-thoracic tumours?
A 55-year-old man with long-standing Barrett's oesophagus is found to have low-grade dysplasia on two consecutive endoscopies 6 months apart. What is the MOST appropriate management?
A 60-year-old man undergoes total gastrectomy for gastric carcinoma. Three months later he presents with diarrhoea, bloating, and weight loss after fatty meals. Which of the following is the MOST likely metabolic complication?
Which of the following features on endoscopy and histology is MOST consistent with a malignant gastric ulcer rather than a benign peptic ulcer?
A 65-year-old man has a cT3N1M0 squamous cell carcinoma of the mid-thoracic oesophagus. CROSS trial–based neoadjuvant chemoradiotherapy (carboplatin + paclitaxel + concurrent 41.4 Gy RT) is planned. What was the pathological complete response rate and survival benefit demonstrated in the CROSS trial?
A 55-year-old woman has a type III hiatus hernia (paraesophageal hernia) on CT scan with the gastric fundus herniated into the chest. She is asymptomatic. What is the recommended management?
In laparoscopic antireflux surgery, the Toupet fundoplication is a partial posterior wrap (270°). Compared to the 360° Nissen fundoplication, the Toupet has the advantage of:
Borrmann classification of gastric carcinoma is based on macroscopic appearance. A Borrmann Type IV tumour (linitis plastica) is characterised by:
Perforated peptic ulcer is managed surgically by simple closure with an omental patch (Graham patch). Which is the correct indications/contraindications balance for adding a definitive anti-ulcer procedure (e.g., truncal vagotomy + pyloroplasty) at the time of emergency laparotomy?
A 63-year-old man undergoes subtotal oesophagectomy with gastric conduit for mid-oesophageal squamous cell carcinoma. On day 5 postoperatively, he develops tachycardia, pyrexia, and surgical emphysema in the neck. Which complication has occurred and what is the investigation of choice?
In the Siewert classification of gastroesophageal junction (GEJ) tumours, a Type II adenocarcinoma (true cardia tumour) originates from:

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