Digestive System
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According to the Haraldsson  classification, Type 2 and 3 are usually the most difficult- Type 3 is normally quite challenging as papilla is  protruding or bulging into the duodenal lumen or sometimes hanging down, pendulous , mobile and with the orifice oriented caudally. This papilla asociates a higher risk of failure OR 7.4 compared to type 1, followed closely by type 2 which is flat and small and associates also more risk of pancreatitis.
See image and data from retrospective database

Although Adenocarcinoma is the most rapidly growing esophageal cancer, still the most common type of esophageal cancer worldwide is esophageal squamous cell carcinoma (SCC). The highest-risk area, called the “esophageal cancer belt,” includes portions of northern Iran, southern Russia, central Asian countries, and northern China, where SCC dominates all cases by 90%. These are very dense populated areas.

However, in Western countries like the United States, esophageal adenocarcinoma has become more common in recent decades, particularly in the lower part of the esophagus and the gastroesophageal junction (GEJ). This increase in adenocarcinoma is often linked to conditions like Barrett esophagus and gastroesophageal reflux disease (GERD).

In summary:

• Worldwide: Esophageal squamous cell carcinoma (SCC) is the most common.
• Western countries (US and Europe): Esophageal adenocarcinoma has surpassed SCC in incidence.

Even though only 10% of hep B infections will become chronic and we have an effective vaccination that can virtually prevent infection, the reality is that hepatitis B incidence and prevalence is very high.  WHO estimates that 254 million people were living with chronic hepatitis B infection in 2022, with 1.2 million new infections each year. Maternal-to-newborn perinatal transmission of the virus can be high (70 to 90% in HBeAg-positive-indicating high viral replication-, or 10% to 30% if the mother is HBeAg-negative )

Hepatitis C , despite easy to become chronic (80% of infections) and no effective vaccine, is less common, (Estimated 50 million worldwide) partly because the vertical transmission is low and also because the new  direct-acting antiviral (DAA) tablets are highly effective at clearing the infection in more than 90% , reducing transmission.

Andexanet is factor Xa inhibitor which is approved to reverse Rivaroxaban and Apixaban. However, it has not being proved to be efficacious against Edoxaban. Dabigatran is  a direct thrombin (factor IIa) inhibitor, not a Xa inhibitor.

-MRCP does not usually require contrast.  The technique enhances any fluid  (the normal fluid which is present in the biliary and pancreatic ducts) as an intrinsic contrast medium by using heavily T2-weighted sequences. T2 potentiate water , therefore this structures will appear hyperintense against the surrounding non-fluid-containing tissues. We can see structures like stomach or duodenum being also bright due to the fluid content.

-Gadolinum is the typical MRI contrast causing brigher T1-weighted images , helping detection of focal lesions (e.g. tumor, abscess, metastasis) venography or calculating MR perfusion parameters.

-Omnipaque® is a low-osmolar iodinated contrast media is indicated for intravenous, intra-arterial or  oral use. Iodine-based contrast are often used in CT scan.

-SonoVue ® is a constrast based on sulphur hexafluoride microbubbles , which used is mainly on contrast-enhanced ultrasound imaging. Bubbles are extremely small—smaller than a red blood cell—and have a high degree of "echogenicity", reflecting ultrasound waves. Structures with higher echogenicity will be brighter on ultrasound.  The microbubbles dissolve, usually within 10 to 15 minutes, and the gas within them is cleared from the body through exhalation.

- Gastric lesions. Even though ESGE guidelines do not specifically mention EUS in the flowchart staging, the reality is that EUS can clarify lymph nodes and the layer invasion, so realistically can be  useful for all the answers mentioned.