ASGE Annual GI Advanced Practice Provider Course (On-demand) (Day Two)

Video Transcription

Video Summary

The transcript captures a rapid Q&A after morning lectures on pancreatic and liver disorders. For exocrine pancreatic insufficiency (EPI), clinicians repeat fat-soluble vitamin levels 3–6 months after starting pancreatic enzyme replacement therapy (PERT), then yearly if stable. If symptoms improve on PERT despite normal fecal elastase, they continue treatment because elastase is an imperfect indirect test; elastase does not normalize with PERT, though fecal fat may improve. Diet in acute pancreatitis typically starts NPO/clear liquids, then lower-fat, higher-carb reintroduction.<br /><br />Liver discussions include avoiding routine MRCP for mildly elevated bilirubin with elevated AST/ALT without cholestatic markers; instead, fractionate bilirubin and check ALP/GGT, using MRCP/EUS selectively for suspected choledocholithiasis. FIB-4 can screen for fibrosis, with ELF or FibroScan as more accurate follow-up depending on resources. Ascites management emphasizes early diagnostic paracentesis; therapeutic taps and TIPS depend on symptoms, complications, and encephalopathy risk. Elevated isolated indirect bilirubin with normal labs suggests benign Gilbert syndrome. PSC care is mainly surveillance and treating symptoms (e.g., pruritus) or cholangitis while awaiting specialty care. Discrepant nodular imaging with normal stiffness may require biopsy and portal hypertension assessment.

Keywords

exocrine pancreatic insufficiency (EPI)

pancreatic enzyme replacement therapy (PERT) monitoring

acute pancreatitis diet reintroduction

MRCP/EUS indications for choledocholithiasis

liver fibrosis screening (FIB-4, ELF, FibroScan)

ascites management (diagnostic paracentesis, TIPS)