ASGE Annual GI Advanced Practice Provider Course (Virtual) (Day One)

Video Transcription

Video Summary

Clinicians discuss practical GI management questions. For acute IBD flares, intermittent upadacitinib (Rinvoq) may act as a rapid, steroid-sparing option, especially for severe ulcerative colitis and infliximab nonresponders, but choice is patient-dependent and combination therapy requires careful safety assessment; it’s not strictly “Rinvoq versus prednisone.” Fecal calprotectin is used broadly in diarrhea workups to distinguish IBS from inflammatory disease; elevated results in chronic diarrhea generally prompt colonoscopy, while suspected acute infection should be evaluated first since infections can transiently raise calprotectin. If calprotectin stays elevated with a normal colonoscopy, small-bowel evaluation with MRE or capsule endoscopy is considered. Experts address biopsy “seeding” risk: it’s theoretical but usually acceptable when sampled tissue would be removed surgically or when disease is already stage IV; avoid sampling suspected hilar cholangiocarcinoma when transplant/curative surgery is planned. Serous cystadenomas can grow benignly; after stable serial imaging and markers, surveillance may stop. Additional topics include pancreatic cancer risk screening (genetic testing), J-pouch diarrhea, gastroparesis limits, and imaging for exocrine pancreatic insufficiency.

Keywords

Upadacitinib (Rinvoq) for acute IBD flare steroid-sparing therapy

Fecal calprotectin in chronic diarrhea workup (IBS vs IBD)

Persistent elevated calprotectin with normal colonoscopy—small bowel evaluation (MRE/capsule)

Biopsy tract seeding risk in cholangiocarcinoma and transplant planning

Serous cystadenoma surveillance discontinuation after stable imaging