ASGE Annual GI Advanced Practice Provider Course (On-demand) (Day Two) | March 2026-Hit Me With Your Best Shot! Live Case Challenge

Video Transcription

Video Summary

The session shifts into an interactive “case challenges” segment as faculty answer audience questions, then plans to discuss managing the in-basket. One case involves a 64-year-old woman with elevated alkaline phosphatase and mild transaminase elevation, negative AMA but positive ANA/ASMA and normal MRCP. Faculty emphasize this pattern raises concern for autoimmune hepatitis (or overlap with PBC) and recommend liver biopsy to clarify diagnosis, noting options beyond percutaneous biopsy (IR-guided, transjugular, and EUS-guided biopsy with potentially better sampling and patient comfort). They highlight autoimmune hepatitis’s wide presentation spectrum and the importance of not missing treatable causes like AIH and Wilson disease.<br /><br />IBD management questions focus on confirming a true flare (rule out infection, assess biomarkers/endoscopy), checking drug levels and dose optimization before switching biologics, and limiting repeated steroid courses.<br /><br />Other cases include a 15 cm liver hemangioma (generally benign but warrants multidisciplinary liver conference review for large lesions), severe bloating/abdominal pain workup (labs, stool tests, EGD/colonoscopy, CT imaging, breath tests, gastric emptying study), refractory H. pylori (consider adherence, allergy verification, culture/susceptibility with ID), unexplained steatorrhea/weight loss (broaden evaluation including small-bowel imaging/capsule), genetic polyposis testing logistics, and suspected Crohn’s with partial SBO and elevated calprotectin. The segment ends by transitioning to inbox management.

Asset Subtitle

Faculty Panel of APPs and Physicians

Keywords

autoimmune hepatitis

PBC-AIH overlap syndrome

liver biopsy (transjugular/EUS-guided)

elevated alkaline phosphatase with negative AMA

IBD flare evaluation and biologic optimization

large liver hemangioma management

refractory Helicobacter pylori treatment

suspected Crohn’s disease with partial small-bowel obstruction