ASGE Annual GI Advanced Practice Provider Course (On-demand) (Day Two) | March 2026-Pancreatitis: Comprehensive Management of Acute and Chronic Cases

Video Transcription

Video Summary

The talk reviews acute and chronic pancreatitis, complications, and management, ending with exocrine pancreatic insufficiency (EPI). Acute pancreatitis presents with sudden severe epigastric pain radiating to the back, nausea/vomiting, and elevated lipase (>3× ULN). Gallstones are now the leading US cause, followed by alcohol; other causes include post-ERCP, very high triglycerides, hypercalcemia, autoimmune disease, and rarely medications. Diagnosis uses the Atlanta criteria (2 of 3: typical pain, elevated enzymes, imaging findings). Severity is defined by organ failure and complications; SIRS is a key marker.<br /><br />Initial management includes NPO (“pancreas rest”), analgesia/antiemetics, careful monitoring, and goal-directed IV fluids. A 2022 RCT showed aggressive fluid resuscitation increases fluid overload without improving outcomes. Antibiotics are not routine—only for cholangitis or suspected infection. ERCP is therapeutic only (e.g., CBD stone/cholangitis, pancreatic duct leaks). Same-admission cholecystectomy is preferred for biliary pancreatitis when feasible. Common complications include pseudocysts, necrosis, obstruction, pleural effusions, and malnutrition; symptomatic pseudocysts are treated with step-up drainage, often endoscopic.<br /><br />Chronic pancreatitis is a fibroinflammatory syndrome (TIGAR-O causes) diagnosed via imaging/EUS plus function tests. Major complications include pain, EPI, malnutrition, bone disease, and increased pancreatic cancer risk (especially hereditary). EPI is common, underdiagnosed, and treated with pancreatic enzyme replacement (typically 40–50k lipase units/meal, higher if needed), correct timing with meals, possible PPI add-on, and nutritional monitoring without unnecessary fat restriction.

Asset Subtitle

Sarah Enslin, PA-C

Keywords

acute pancreatitis

chronic pancreatitis

Atlanta criteria

systemic inflammatory response syndrome (SIRS)

biliary pancreatitis and cholecystectomy

pancreatic pseudocyst and step-up drainage

pancreatic enzyme replacement therapy (PERT)

exocrine pancreatic insufficiency (EPI)