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100+ Free ABPS GI Endoscopy Practice Questions

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~70-85% first-time pass rate among eligible candidates (ABPS/BCGE statistics) Pass Rate
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According to ASGE 2015 (reaffirmed) antibiotic prophylaxis guidelines, in which of the following endoscopic scenarios is antibiotic prophylaxis clearly indicated?

A
B
C
D
to track
2026 Statistics

Key Facts: ABPS GI Endoscopy Exam

~200

Total MCQ Items

ABPS/BCGE Gastrointestinal Endoscopy Examination

~4-5 hr

Total Exam Time

Computer-based examination at ABPS-approved centers

~23%

Colonoscopy / LGI Weight

Largest single domain on 2026 BCGE content outline

~$2,500

2026 Examination Fee

ABPS/BCGE (verify current schedule)

≥25% / ≥20%

Screening ADR (M/F)

ASGE/ACG quality indicator for colonoscopy

45-75

USPSTF 2021 CRC Screening Age

Average-risk adults — lowered from 50 in 2021

The ABPS GI Endoscopy Certification Exam (BCGE) is a computer-based test from the American Board of Physician Specialties comprising ~200 single-best-answer MCQs over ~4-5 hours. Content spans colonoscopy/LGI (~23%), upper endoscopy (~22%), ERCP (~14%), pre-procedure and sedation (~11%), EUS (~9%), complications (~8%), capsule/enteroscopy (~4%), quality/MIPS (~4%), infection control (~3%), ethics (~2%), and pediatric (~1%). Examination fee is ~$2,500; candidates must hold an MD/DO with valid unrestricted license, primary specialty in a related field (FP/IM/surgery/GI), and demonstrated training plus procedure logs in GI endoscopy.

Sample ABPS GI Endoscopy Practice Questions

Try these sample questions to test your ABPS GI Endoscopy exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1According to ASGE 2015 (reaffirmed) antibiotic prophylaxis guidelines, in which of the following endoscopic scenarios is antibiotic prophylaxis clearly indicated?
A.Routine screening colonoscopy in a healthy patient
B.Diagnostic EGD with mucosal biopsy in a patient with a prosthetic hip
C.PEG tube placement (prior to insertion) using a single dose of cefazolin
D.Diagnostic ERCP with no evidence of biliary obstruction
Explanation: ASGE recommends a single pre-procedure dose of a first-generation cephalosporin (cefazolin) or ampicillin/sulbactam before PEG placement to reduce peristomal infection. Prophylaxis is NOT recommended for routine diagnostic endoscopy (even with prosthetic joints) or for ERCP without obstruction. Obstructed biliary systems (incomplete drainage) and cirrhosis with acute GI bleed DO require prophylaxis.
2Per ASGE 2022 periprocedural anticoagulation guidance, for a patient on apixaban undergoing a HIGH-risk bleeding endoscopic procedure (e.g., polypectomy of a 2 cm polyp), the recommended duration to hold apixaban pre-procedure is:
A.12 hours
B.24-48 hours depending on renal function
C.5 days
D.No hold required
Explanation: ASGE 2022 recommends holding DOACs (apixaban, rivaroxaban, dabigatran, edoxaban) for 48 hours prior to high-risk procedures (24 hours for low-risk). Longer holds (up to 4 days) are recommended for dabigatran when CrCl is reduced. Warfarin is held 5 days for high-risk procedures; aspirin is generally continued.
3The preferred bowel preparation regimen that maximizes adenoma detection during screening colonoscopy is:
A.Single-dose 4 L PEG the evening before
B.Split-dose PEG (half evening before, half morning of)
C.Oral sodium phosphate single dose
D.Magnesium citrate alone
Explanation: The US Multi-Society Task Force and ASGE endorse split-dose bowel preparation as the standard of care: half the evening before and half 4-6 hours before the procedure. Split-dose improves right-colon cleansing and adenoma detection compared to single-dose regimens. Oral sodium phosphate is avoided due to renal toxicity.
4A 68-year-old with COPD, BMI 38, OSA, and difficult prior intubation history is scheduled for EGD. The MOST appropriate sedation plan is:
A.Moderate sedation with midazolam and fentanyl by the endoscopist
B.MAC (monitored anesthesia care) with propofol by an anesthesia provider
C.Topical anesthesia only
D.General anesthesia with endotracheal intubation is mandatory
Explanation: ASA class III-IV patients, OSA, morbid obesity, and anticipated difficult airway are indications for anesthesia-assisted sedation (MAC with propofol). Moderate sedation by the endoscopist is appropriate for ASA I-II without risk factors. General anesthesia with intubation is not routinely required for EGD.
5A patient receiving midazolam and fentanyl becomes apneic with SpO2 88%. After airway maneuvers and bag-mask ventilation, which reversal agent should be administered FIRST?
A.Flumazenil 0.2 mg IV
B.Naloxone 0.4 mg IV
C.Neostigmine
D.Protamine
Explanation: Opioid-induced respiratory depression is the most common cause of apnea in combined benzodiazepine/opioid sedation. Naloxone (0.04-0.4 mg IV) is given first because it reverses respiratory depression rapidly. Flumazenil (0.2 mg increments) reverses benzodiazepines but can precipitate seizures in chronic users.
6The Los Angeles Classification grade D reflux esophagitis is defined as:
A.One or more mucosal breaks ≤5 mm not extending between top of mucosal folds
B.One or more mucosal breaks >5 mm not extending between top of mucosal folds
C.Mucosal breaks bridging ≥2 fold tops but <75% circumference
D.Mucosal breaks involving ≥75% of the esophageal circumference
Explanation: LA Classification: A = breaks ≤5 mm not bridging folds; B = >5 mm not bridging; C = bridging ≥2 folds but <75% circumference; D = ≥75% circumference. Grades C/D are severe erosive esophagitis and confirm pathologic reflux without requiring pH monitoring per Lyon Consensus.
7Per the Seattle protocol for Barrett esophagus surveillance, the correct biopsy technique is:
A.Targeted biopsies of visible lesions only
B.Four-quadrant biopsies every 1-2 cm throughout the Barrett segment plus targeted biopsies
C.Single biopsy of the squamocolumnar junction
D.Random biopsies every 5 cm
Explanation: The Seattle protocol requires 4-quadrant biopsies every 2 cm in non-dysplastic BE (every 1 cm if prior dysplasia) PLUS targeted biopsies of all visible lesions. Prague C&M criteria describe circumferential (C) and maximum (M) extent. Adherence improves dysplasia detection; WATS-3D brush cytology is adjunctive.
8A Barrett segment described as C4 M7 under the Prague classification means:
A.Circumferential extent 7 cm, maximum extent 4 cm
B.Circumferential extent 4 cm, maximum extent 7 cm
C.Four biopsies positive out of seven
D.Grade 4 dysplasia at 7 cm
Explanation: Prague C & M: C = circumferential extent of Barrett (cm from GEJ), M = maximal extent (cm from GEJ to top of any tongue). C4 M7 = 4 cm circumferential with a tongue extending to 7 cm above GEJ. Both are measured from the top of the gastric folds.
9Biopsy of the esophagus in suspected eosinophilic esophagitis requires how many eosinophils per high-power field to establish the diagnosis (per AGREE consensus 2018)?
A.≥5 eos/HPF
B.≥10 eos/HPF
C.≥15 eos/HPF
D.≥30 eos/HPF
Explanation: The AGREE consensus (2018) and current AGA/ACG guidelines require ≥15 eosinophils/HPF on esophageal biopsy PLUS clinical symptoms of esophageal dysfunction (dysphagia, food impaction). Take 2-4 biopsies each from distal and proximal esophagus. PPI-responsive EoE is now considered EoE (no longer a separate entity).
10A patient with a bleeding gastric ulcer shows a non-bleeding visible vessel (pigmented protuberance) without active bleeding. This is Forrest class:
A.Forrest Ia
B.Forrest Ib
C.Forrest IIa
D.Forrest III
Explanation: Forrest classification for peptic ulcer bleeding: Ia = arterial spurting; Ib = active oozing; IIa = non-bleeding visible vessel (rebleed ~43%); IIb = adherent clot (~22%); IIc = flat pigmented spot (~10%); III = clean base (~5%). High-risk stigmata (Ia/Ib/IIa, and IIb after clot removal) warrant endoscopic therapy.

About the ABPS GI Endoscopy Exam

The ABPS Gastrointestinal Endoscopy Certification Examination, administered by the Board of Certification in Gastrointestinal Endoscopy (BCGE), validates knowledge required for independent practice in diagnostic and therapeutic GI endoscopy. Content spans colonoscopy and lower GI (USPSTF 2021 CRC screening 45-75, USMSTF 2020 polyp surveillance, ADR/cecal intubation/withdrawal quality metrics, Paris/NICE, BBPS, SCENIC chromoendoscopy in IBD), upper endoscopy (Prague C&M and Seattle protocol for Barrett esophagus, LA grade for erosive esophagitis, Forrest classification for peptic ulcer bleeding, Rockall/Glasgow-Blatchford risk scores, variceal band ligation, EoE, achalasia, Chicago Classification 4.0), ERCP (indications, Elmunzer rectal indomethacin PEP prophylaxis, SEMS/plastic stents, cholangioscopy, Tokyo 2018 cholangitis grading), EUS (Fukuoka/Kyoto IPMN worrisome features and high-risk stigmata, cyst fluid markers, celiac plexus block, LAMS gastroenterostomy), pre-procedure assessment and sedation (NPO, Mallampati/ASA, ASGE 2022 periprocedural anticoagulation, ASGE 2015 antibiotic prophylaxis, capnography), complications management, capsule/enteroscopy, quality/MIPS, infection control and duodenoscope reprocessing (FDA 2022 disposable distal tip transition), ethics, and pediatric endoscopy. Requires MD/DO with valid unrestricted license, primary specialty in a related field (FP/IM/surgery/GI), and demonstrated training with procedure logs in GI endoscopy.

Questions

200 scored questions

Time Limit

Computer-based exam (~4-5 hours)

Passing Score

Criterion-referenced scaled score set by BCGE (modified Angoff standard)

Exam Fee

~$2,500 examination fee (ABPS/BCGE 2026 — verify current schedule) (American Board of Physician Specialties (ABPS) — Board of Certification in Gastrointestinal Endoscopy (BCGE))

ABPS GI Endoscopy Exam Content Outline

~23%

Colonoscopy & Lower GI

USPSTF 2021 CRC screening ages 45-75, USMSTF 2020 polyp surveillance (1-3 adenomas <10 mm → 7-10 yr; 3-4 or SSL → 3-5 yr; ≥5 or advanced adenoma → 3 yr; piecemeal EMR ≥20 mm → 6 mo), ADR ≥25% men / ≥20% women, cecal intubation ≥95% in screening, withdrawal time ≥6 min, BBPS Boston Bowel Prep ≥2 per segment, split-dose PEG, NICE/Paris classification, cold snare for ≤9 mm, EMR, ESD, SCENIC chromoendoscopy for IBD surveillance, diverticular bleeding, ischemic colitis, pseudomembranous colitis.

~22%

Upper Endoscopy (EGD)

Prague C&M for Barrett esophagus, Seattle biopsy protocol (4-quadrant q2 cm; q1 cm with dysplasia), LA grade A-D erosive esophagitis, Forrest classification (Ia spurting, Ib oozing, IIa visible vessel, IIb adherent clot, IIc flat pigment, III clean base), Rockall and Glasgow-Blatchford risk scores, variceal band ligation + octreotide, eosinophilic esophagitis (≥15 eos/hpf), achalasia (Chicago Classification 4.0 — type I absent contractility, II pan-esophageal pressurization, III spastic), GAVE (APC), Mallory-Weiss, Dieulafoy, over-the-scope clip, Hemospray.

~14%

ERCP

Indications (choledocholithiasis with cholangitis/jaundice, malignant biliary obstruction, post-op bile leak, Rome IV sphincter of Oddi Type I), Elmunzer NEJM rectal indomethacin 100 mg pre/post ERCP for PEP prophylaxis in high-risk patients, pancreatic duct stent for PEP prevention, wire-guided cannulation, sphincterotomy, SEMS vs plastic, cholangioscopy (SpyGlass), Tokyo 2018 cholangitis grading (mild/moderate/severe), complications (PEP 2-10%, bleeding, perforation, cholangitis).

~11%

Pre-Procedure Assessment & Sedation

Informed consent, ASA physical status I-V, Mallampati I-IV, NPO (2 hr clear liquids, 6 hr light meal, 8 hr fatty meal), ASGE 2022 periprocedural anticoagulation (DOACs held 24-48 hr depending on renal function and bleeding risk; warfarin 5 d for high-risk; aspirin generally continued; LMWH bridging for mechanical valves), ASGE 2015 antibiotic prophylaxis (cefazolin for PEG; ciprofloxacin for obstructed bile duct incomplete drainage; NOT routine diagnostic), moderate vs deep sedation (propofol anesthesia-directed), capnography.

~9%

Endoscopic Ultrasound (EUS)

EUS-FNA/FNB for pancreatic masses, subepithelial lesions (GIST — CD117/DOG1; leiomyoma, lipoma, carcinoid), pancreatic cystic neoplasms — Fukuoka worrisome features (cyst ≥3 cm, MPD 5-9 mm, mural nodule, thickened enhancing wall) and high-risk stigmata (obstructive jaundice, enhancing mural nodule ≥5 mm, MPD ≥10 mm); Kyoto 2024 IPMN guidance; cyst fluid CEA (high = mucinous), glucose (low = mucinous), KRAS/GNAS (IPMN), rectal cancer T/N staging, mediastinal adenopathy, celiac plexus block/neurolysis, EUS-BD, LAMS gastroenterostomy.

~8%

Complications Management

Perforation (colon — clip, OTSC, surgery; esophagus — stent), post-polypectomy bleeding (clip, coagulation), post-ERCP pancreatitis (IV LR, rectal NSAIDs prophylaxis, PD stent), cholangitis (antibiotics + drainage — Tokyo guidelines), aspiration pneumonitis, sedation events (hypoxia → jaw thrust, oral airway, reversal — naloxone, flumazenil), duodenoscope-associated infections, deep venous thrombosis, adverse event reporting.

~4%

Capsule Endoscopy & Enteroscopy

Small bowel capsule endoscopy for obscure GI bleeding (after normal EGD and colonoscopy), Crohn small bowel, celiac disease, retention risk with patency capsule, contraindications (known/suspected obstruction, dysphagia, pacemaker relative), push enteroscopy, balloon-assisted enteroscopy (single- and double-balloon), spiral enteroscopy, therapeutic enteroscopy for deep small bowel lesions.

~4%

Quality, MIPS & Documentation

ASGE/ACG quality indicators (ADR, cecal intubation rate, withdrawal time, bowel prep adequacy, appropriate surveillance recommendations, BBPS), MIPS measures, GIQuIC registry participation, procedure documentation, image capture of landmarks (cecum, terminal ileum, anastomosis, Z-line), complication reporting, peer review, continuous quality improvement.

~3%

Infection Control & Reprocessing

Spaulding classification (endoscopes semi-critical → high-level disinfection), FDA 2022 duodenoscope disposable distal tip/cap transition following CRE outbreak, manual cleaning then AER (automated endoscope reprocessor), high-level disinfectants (glutaraldehyde, OPA, peracetic acid), surveillance cultures, borescope inspection, single-use duodenoscopes (EXALT Model D), channel brushing, drying and storage, hand hygiene, PPE.

~2%

Ethics, Consent & Safety

Informed consent (material risks, alternatives including no procedure), capacity assessment, surrogate decision-making, time-out and universal protocol, WHO surgical safety checklist, never events, specimen handling and chain of custody, disclosure of adverse events, billing ethics, conflicts of interest, research ethics (IRB, informed consent for studies).

~1%

Pediatric Endoscopy

Indications (hematemesis, foreign body, caustic ingestion, suspected EoE, chronic diarrhea, IBD evaluation), pediatric scopes and accessories, sedation considerations, button battery esophageal impaction — EMERGENT removal within 2 hr for severe mucosal injury risk, coin vs battery differentiation (halo sign on AP, step-off on lateral), achalasia in children (Heller vs POEM).

How to Pass the ABPS GI Endoscopy Exam

What You Need to Know

  • Passing score: Criterion-referenced scaled score set by BCGE (modified Angoff standard)
  • Exam length: 200 questions
  • Time limit: Computer-based exam (~4-5 hours)
  • Exam fee: ~$2,500 examination fee (ABPS/BCGE 2026 — verify current schedule)

Keys to Passing

  • Complete 500+ practice questions
  • Score 80%+ consistently before scheduling
  • Focus on highest-weighted sections
  • Use our AI tutor for tough concepts

ABPS GI Endoscopy Study Tips from Top Performers

1USMSTF 2020 post-polypectomy surveillance intervals — high-yield: 1-2 tubular adenomas <10 mm → 7-10 yr; 3-4 adenomas <10 mm or any sessile serrated lesion <10 mm → 3-5 yr; ≥5 adenomas OR any advanced adenoma (≥10 mm, villous, high-grade dysplasia) OR SSL with dysplasia/TSA → 3 yr; piecemeal EMR of a lesion ≥20 mm → 6 months. USPSTF 2021 now screens average-risk adults 45-75.
2ASGE 2022 periprocedural anticoagulation: DOACs (apixaban, rivaroxaban, dabigatran, edoxaban) are held 24 hours before LOW-risk and 48 hours before HIGH-risk bleeding procedures (longer for dabigatran when CrCl is reduced). Warfarin is held 5 days for high-risk. Aspirin is generally continued. LMWH bridging is reserved for high thromboembolic risk (mechanical mitral valve, recent VTE, CHA2DS2-VASc ≥5 with AF).
3Forrest classification of peptic ulcer bleeding and rebleed risk: Ia (active spurting — ~90%), Ib (active oozing — 10-20%), IIa (non-bleeding visible vessel — ~50%), IIb (adherent clot — 25-30%), IIc (flat pigmented spot — <10%), III (clean base — <5%). Endoscopic therapy is indicated for Ia, Ib, IIa; IIb is controversial (clot irrigation/removal then treat); IIc/III typically do not need therapy.
4Elmunzer et al. NEJM 2012 — rectal indomethacin 100 mg immediately BEFORE or AFTER ERCP reduces post-ERCP pancreatitis in high-risk patients (SOD, prior PEP, precut sphincterotomy, pancreatic duct injection, difficult cannulation, ampullectomy, young female). Combine with pancreatic duct stenting in highest-risk cases. IV aggressive hydration with lactated Ringer's is also protective.
5Fukuoka/Kyoto guidelines for IPMN — distinguish WORRISOME features (cyst ≥3 cm, thickened enhancing wall, MPD 5-9 mm, non-enhancing mural nodule, abrupt caliber change with distal atrophy, lymphadenopathy, elevated CA 19-9, rapid growth ≥5 mm in 2 yr) from HIGH-RISK stigmata (obstructive jaundice with cystic head lesion, enhancing mural nodule ≥5 mm, main pancreatic duct ≥10 mm). High-risk stigmata → resection; worrisome features → EUS-FNA and close surveillance.

Frequently Asked Questions

What is the ABPS Gastrointestinal Endoscopy Certification Examination?

The ABPS GI Endoscopy Examination is administered by the Board of Certification in Gastrointestinal Endoscopy (BCGE) under the American Board of Physician Specialties (ABPS). It validates the breadth of knowledge required for independent practice in diagnostic and therapeutic GI endoscopy, spanning colonoscopy, upper endoscopy, ERCP, EUS, sedation, complications management, capsule/enteroscopy, quality and infection control, and pediatric endoscopy. It is an alternative pathway to board certification for practicing endoscopists from multiple primary specialties.

Who is eligible to take the BCGE exam?

Candidates must hold an MD or DO degree (or equivalent) with a valid unrestricted medical license, be certified or trained in a related primary specialty (family medicine, internal medicine, general surgery, or gastroenterology), and demonstrate documented training in GI endoscopy with procedure logs signed by a qualified proctor. Applicants must meet the BCGE minimum annual procedure volume requirements and submit letters of reference.

What is the format of the BCGE exam?

The BCGE examination is a computer-based test with approximately 200 single-best-answer multiple-choice questions administered over roughly 4-5 hours at ABPS-approved test centers. Items are blueprinted to the BCGE content outline with a heavy emphasis on colonoscopy and lower GI (~23%), upper endoscopy (~22%), ERCP (~14%), and pre-procedure/sedation (~11%). Clinical vignettes, endoscopic images, and imaging are commonly used.

How much does the 2026 BCGE exam cost?

The 2026 BCGE examination fee is approximately $2,500 — always verify the current schedule on the ABPS/BCGE website. Cancellation and refund policies follow the BCGE schedule with decreasing refunds as the exam date approaches. Retakes require re-registration and full fee payment within the allowed qualification window, and remediation may be required after failed attempts.

When is the 2026 exam administered?

The BCGE examination is typically offered during published testing windows each year. Applications generally open months in advance of each window with a submission deadline and requirements for procedure logs and references. Candidates schedule specific appointments after application approval. Exact 2026 dates should be confirmed on the ABPS/BCGE page.

How is the exam scored?

BCGE uses criterion-referenced scaled scoring with a passing standard set by subject-matter experts using the modified Angoff method. A candidate's pass/fail result depends on performance relative to the fixed cut-score, not on other candidates. Score reports typically include domain-level feedback to guide remediation if needed.

What are the highest-yield topics?

Highest-yield topics include USPSTF 2021 CRC screening (45-75), USMSTF 2020 polyp surveillance intervals, ADR/cecal intubation/withdrawal time quality metrics, BBPS bowel prep, ASGE 2022 periprocedural anticoagulation (DOAC 24-48 hr hold), ASGE 2015 antibiotic prophylaxis, Forrest classification for PUD bleeding, Prague C&M and Seattle protocol for Barrett, Rockall/Glasgow-Blatchford, Chicago Classification 4.0 for achalasia, Elmunzer rectal indomethacin for PEP prophylaxis, Fukuoka IPMN worrisome features, and FDA 2022 duodenoscope disposable tip transition.

How should I study for this exam?

Use a structured 6-12 month plan layered on active endoscopic practice. Map to the BCGE content outline: begin with pre-procedure assessment and sedation, then colonoscopy and upper endoscopy, followed by ERCP and EUS, and finally complications, capsule/enteroscopy, quality, infection control, ethics, and pediatric topics. Integrate ASGE/ACG guidelines, Sleisenger and Fordtran's, Cotton/Leung ERCP, and high-volume MCQ practice. Complete 2-3 full-length timed mock exams. Drill guideline citations, scores, and endoscopic image recognition.