Scope It Out Case Answers 
Fall 2025

B. Both FDA and EASL recommend withholding terlipressin and decreasing albumin if there is hypoxemia (SpO2<90%) or evidence of volume overload or ischemia, regardless of renal response due to the risk of respiratory and cardiac complications. 

 

Summer 2025

 

​B. LES Botulinum toxin injection

Botox is the best option even though it may only provide short-term relief. Patient is not a candidate for Heller myotomy because severe comorbidities. Pneumatic dilation is not a reasonable option due to risk of perforation which would require surgery to correct. POEM would not be considered a safer alternative to Heller myotomy or pneumatic dilation. Sildenafil is not a treatment for type II achalasia and heart failure would be a contraindication. Nitrates and calcium channel blockers are less effective.