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

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This document is a teaching session (“Hit Me With Your Best Shot!”) from the ASGE 2026 APP Course (March 21, 2026) presenting three gastroenterology cases that emphasize diagnostic reasoning and avoiding premature closure.

<strong>Case 1 (65-year-old woman, presumed diverticulitis):</strong> She presented with months of constipation and new left lower quadrant (LLQ) pain/bloating. Prior colonoscopy showed only sigmoid diverticulosis and an abdominal x-ray showed stool burden. Initial management focused on constipation (labs including CMP/electrolytes/TSH; polyethylene glycol twice daily plus fiber), with plans for motility testing if needed. When pain worsened, CT revealed diverticulosis with colonic wall thickening/stranding but also a large right ovarian cystic/solid mass and peritoneal nodularity suggestive of carcinomatosis. Pelvic MRI characterized the adnexal mass as O-RADS 5 with peritoneal carcinomatosis and ascites. Despite empiric antibiotics for diverticulitis, symptoms did not improve. Gynecologic oncology evaluation and laparoscopy confirmed primary ovarian carcinoma with extensive unresectable peritoneal carcinomatosis (omental cake, colonic and diaphragmatic involvement). She was discharged and requested palliative care.

<strong>Case 2 (61-year-old man, severe nocturnal abdominal pain):</strong> He had sudden crampy periumbilical pain starting around Thanksgiving, worse at night and relieved by walking, with weight loss and new constipation. Initial urgent care assessment favored GERD; labs were normal. CT ultimately showed a pancreatic head/neck/body mass with vascular encasement and portal/splenic vein involvement, plus liver and peritoneal metastases. EUS-FNA confirmed pancreatic ductal adenocarcinoma with metastatic peripancreatic nodes (stage IV). He received a celiac plexus block and pursued palliative/hospice care.

<strong>Case 3 (22-year-old woman, RLQ pain and diarrhea):</strong> Chronic RLQ pain worsened with frequent loose stools, mucus, and blood. CT showed reactive RLQ mesenteric nodes. EGD was normal; colonoscopy was limited by poor prep; fecal calprotectin and labs were normal. MR enterography suggested terminal ileal Crohn’s, but expanded stool testing identified <strong>Yersinia enterocolitica</strong>, explaining “pseudoappendicitis”-type RLQ pain. She improved with ciprofloxacin.

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Faculty Panel of APPs and Physicians

Keywords

ASGE 2026 APP Course

diagnostic reasoning

premature closure avoidance

ovarian carcinoma

peritoneal carcinomatosis

diverticulitis mimic

pancreatic ductal adenocarcinoma

EUS-FNA staging

celiac plexus block

Yersinia enterocolitica pseudoappendicitis