Module: Understanding Pancreatitis
Expert Video - What is the pancreas and what does it do?
Physicians describe the pancreas and the role it plays in the body, specifically the digestive system. They also briefly touch on what happens when the pancreas doesn’t work properly.
Expert Video - How can you keep the pancreas healthy?
Physicians describe ways to keep the pancreas healthy, including limiting alcohol, stopping smoking and the importance of diet, especially the role of fat in the diet.
Expert Video - What is acute pancreatitis and what are its causes and symptoms?
Physicians discuss the causes of acute pancreatitis, including the symptoms and why they are so severe. They also discuss the importance of getting checked if something feels wrong.
Expert Video - How is acute pancreatitis diagnosed?
Physicians discuss how they diagnose acute pancreatitis, including the symptoms that allude to the ailment and the follow-up tests that confirm the diagnosis.
Expert Video - What are some of the consequences of acute pancreatitis?
Physicians discuss some of the long-term consequences of repeat attacks and severe acute pancreatitis, including loss of function.
Expert Video - What is the link between alcohol and acute pancreatitis?
Physicians discuss the role of alcohol in acute pancreatitis, including the amount of alcohol consumption that increases the risk, and whether certain people may be more inclined to develop alcohol-related acute pancreatitis.
Expert Video - What is chronic pancreatitis and what are its causes and symptoms?
Physicians discuss chronic pancreatitis, including causes, risk factors and long-term consequences like nutrition-related diseases and EPI.
Expert Video - How is chronic pancreatitis diagnosed?
Physicians discuss how they diagnose chronic pancreatitis, including lifestyle factors and symptoms that lead them to suspect a disease of the pancreas, and the follow-up tests that confirm the diagnosis of chronic pancreatitis.
Expert Video - What is the link between alcohol, tobacco and chronic pancreatitis?
Physicians discuss the role of alcohol and tobacco consumption in chronic pancreatitis, including the amount of alcohol consumption that increases the risk, and whether certain people may be more inclined to develop alcohol-related acute pancreatitis.
Expert Video - What is exocrine pancreatic insufficiency (EPI) and what are its causes and symptoms?
Physicians discuss EPI, including causes, risk factors and long-term consequences like nutrition-related diseases. They also discuss inherited conditions that are linked to EPI.
Expert Video - How is exocrine pancreatic insufficiency (EPI) diagnosed?
Physicians discuss how they diagnose EPI, including lifestyle factors and symptoms that lead them to suspect EPI, and the follow-up tests that confirm the diagnosis.
Expert Video - How is exocrine pancreatic insufficiency (EPI) treated?
Physicians discuss the approaches to treating EPI including pancreatic enzyme replacement therapy (PERT), vitamin and mineral supplementation, and dietary interventions. They also discuss when they decide to implement PERT.
Module: Management of Pancreatitis
Expert Video - How is acute pancreatitis treated?
Physicians discuss the approaches to treating acute pancreatitis, including what measures may be needed for more serious attacks like dialysis, the insertion of a breathing tube, or surgery.
Expert Video - What are pancreatic cysts and how are they treated?
Physicians describe cysts, why they form, and how they are treated.
Expert Video - How likely is it that I will have another attack of acute pancreatitis?
Physicians discuss the likelihood of having multiple attacks of acute pancreatitis and ways to avoid subsequent episodes, including limiting alcohol and high fat food, stopping smoking and the importance of diet and keeping triglycerides in line.
Expert Video - What can I expect following an attack of acute pancreatitis?
Physicians discuss how acute pancreatitis affects the pancreas and digestive system, including destruction of pancreatic tissue in some cases. Discussion also includes what to expect if sufficient pancreatic tissue is destroyed to affect pancreatic function. EPI is mentioned briefly but is not a focus.
Expert Video - Acute Pancreatitis: What foods and beverages should I avoid?
Physicians describe in a fair amount of detail what foods and beverages should be avoided to reduce stress on the pancreas, and which ones are always good to include in the diet.
Expert Video - How is chronic pancreatitis treated?
Physicians discuss the goals of treatment for chronic pancreatitis and how these are achieved. Approaches to pain management and the importance lifestyle changes such as stopping drinking and avoiding high-fat foods are discussed.
Expert Video - How will I know if I’m not absorbing nutrients well?
Physicians describe the most common nutrition-related diseases that patients with chronic pancreatitis are at risk for, what symptoms to look out for, and what tests can help diagnose nutrition-related disease.
Expert Video - What is pancreatic enzyme replacement therapy (PERT)?
Physicians discuss PERT, why it is needed, when they prescribe it, and how patients should take it.
Expert Video - What can I expect following diagnosis of chronic pancreatitis?
Physicians discuss outcomes and disease progression in chronic pancreatitis, as well as the nutritional and lifestyle changes that need to be made following diagnosis.
Expert Video - What are pancreatic stones and how are they treated?
Physicians describe pancreatic stones, why they form, and how they are treated, including the various types of surgeries.
Expert Video - Chronic Pancreatitis: What foods and beverages should I avoid?
Physicians describe in a fair amount of detail what foods and beverages should be avoided to reduce stress on the pancreas, and which ones are always good to include in the diet.
Expert Video - Why are we seeing increases in pediatric pancreatitis?
Physicians discuss the increase in pancreatitis in children, and the diagnosis of the disease in young people.
Module: Pancreatic Cancer
Expert Video - What are the symptoms of pancreatic cancer?
Physicians discuss the symptoms of pancreatic cancer, including how there are frequently no symptoms early on in the disease.
Expert Video - How can I reduce my risk for developing pancreatic cancer?

Physicians describe the most common risk factors for pancreatic cancer (cigarette smoking, industrial chemical exposure, obesity, high fat intake, long-standing diabetes, long-standing chronic pancreatitis) and how the risk can be reduced.

They also discuss screening registries for high-risk individuals.

Expert Video - How is pancreatic cancer diagnosed?
Physicians discuss when they suspect pancreatic cancer and what tests they use to confirm that diagnosis or to rule out other conditions.
Expert Video - What are the different stages of pancreatic cancer?
Physicians describe the staging of pancreatic cancer.
Expert Video - How is pancreatic cancer treated?
Physicians discuss the goals of treatment for pancreatic cancer and how they decide which patients are candidates for curative treatment and which ones are palliative.
Expert Video - What is “curative treatment” for pancreatic cancer?

Physicians discuss the treatment options for patients who are candidates for curative treatment.

They also talk about the outcomes associated with curative treatment, including survival rates.

Expert Video - What is “palliative treatment” for pancreatic cancer?
Physicians discuss the treatment options for patients who are palliative, including how much treatment can realistically slow the disease and what impact treatment can have on quality of life.
Expert Video - What kinds of surgeries are performed to remove malignant pancreatic cancer tumors?

Physicians describe the various surgical resection procedures used for pancreatic cancer.

An emphasis is put on the Whipple procedure.

They also describe what patients should expect going into surgery.

Expert Video - What should I expect following surgery to remove a malignant pancreatic cancer tumor?

Physicians describe the recovery process following surgical resection procedures for pancreatic cancer, including the most common complications. They talk about chemotherapy and radiation therapy, when these are used and why, and how long after surgery chemotherapy or radiation therapy is started. They also discuss supportive medications following surgery, including length of treatment and possible side-effects.

Expert Video - Should I participate in a clinical trial?
Physicians discuss the important role of clinical trials in advancing the field of pancreatic cancer and improving outcomes for patients and their families. They describe the goals, benefits and different types of clinical trials, and encourage patients to consider participation.
Expert Video - What new advances are there in the treatment of pancreatic cancer?
Physicians discuss new research and medications that are in development for the treatment of pancreatic cancer. They also talk about advances in genetic research and screening opportunities.
Expert Video - What is a clinical trial?
Physicians describe what a clinical trial is. Clinical trials are research studies that evaluate new ways to improve treatments and quality of life for people with diseases, like pancreatic cancer. A clinical trial can be part of a number of scenarios and patients can participate in many ways. A clinical trial is how we make progress in cancer research. All the drugs and tools that we have today came about because patients volunteered for clinical trials.
Expert Video - Why are clinical trials important?
Physicians discuss why clinical trials are important. When it comes to a disease like pancreatic cancer, even though we have made progress we still have a long way to go to improve outcomes for pancreatic cancer patients - and the best way to do that is to test new treatments and new diagnostic tools through clinical trials. By being in a clinical trial patients may benefit from a new treatment, as well as contribute to science and moving the field of medicine forward.
Expert Video - How do clinical trials work? How are they conducted?
Physicians explain how clinical trials work and the different types of clinical trials and stages – from early stage to late stage. In a clinical trial, there is an individual called the principle investigator, who has primary responsibility for the conduct of the trial, and he or she will work with a team, usually a research nurse and several study coordinators and data managers. The trial is overseen by an institutional review board (IRB) and other committees that govern the scientific merits of the study, and patient welfare and safety. A clinical trial has to be done under rigorous oversight and controls, so it usually means that patients receive treatment in a clinical trial center and not always with their local community oncologist.
Expert Video - What are the phases of clinical trials?
Physicians discuss the series of steps (called phases) of clinical trials. Each phase is designed to answer important questions that lead to the next phase. If a patient is thinking about a clinical trial, it’s important to understand which phase the trial is in and what the unique protocol (or plan) is for the study and the eligibility criteria.
Expert Video - Who can participate in a clinical trial?
Physicians discuss who can participate in a clinical trial. Whether a patient can be enrolled in a clinical trial depends on what’s referred to as “eligibility criteria”. Eligibility criteria differ from one clinical trial to the next and there is a great deal of variation. The highest priority for a clinical trial is to minimize the potential for serious risk and harm. It is a lot of work to have a patient enroll in a clinical trial and it requires careful explanation and discussion on the pros and cons to make sure it is the right fit for that person and that they are truly comfortable with the decision to participate.
Expert Video - Why should a patient join a clinical trial?
Physicians explain the advantages of participating in a clinical trial. By participating in a clinical trial, patients can often expect a higher standard of care, and there is the hope that the clinical trial will benefit the individual patient. We need clinical trials to advance new medical discoveries and to make progress against cancer, so there is also an altruistic aspect to participating in a clinical trial in terms of helping others and advancing medical science.
Expert Video - What are some of the risks and benefits of volunteering for a clinical trial?
Physicians discuss the risks and benefits of volunteering for a clinical trial. In terms of benefits of the clinical trial, basic standard of care is usually covered by a patient’s insurance (for example, physician visits and routine blood tests will be covered by insurance) but patients should check to be sure. Also, a research biopsy (taking a piece of the tissue to look at the genetic makeup of the tumor) would typically be covered, and the experimental drug that’s being studied is provided free of cost as part of the trial. An important part of the risks for patients are side effects. Patients need to have a detailed understanding of what the side effects are, and this is part of the consent process which they need to discuss with the researchers. Participating in a clinical trial is not for the faint of heart. It has to be something that patients are really committed to participating in because it will be a bit more intensive than just regular treatments. Of course there is the potential for higher reward. Patients need to understand both the benefits and risks very clearly before they agree to volunteer.
Expert Video - What is “informed consent” in a clinical trial?
Physicians explain what “informed consent” is in a clinical trial. Informed consent is the process of giving clinical trial participants all of the facts about a trial. Informed consent is greatly important because patients cannot participate in a study without their clear understanding of everything involved. Informed consent means that the patient is making an informed decision on their own, and understands all the risks and benefits for participating in a study. There is a verbal conversation that goes along with this and also a written document. The informed consent document is vetted by an institutional review board (IRB) to make sure it’s not missing anything. Both the physician and the patient will sign the consent form, and then the next step is screening for eligibility and, if the patient qualifies, moving forward with the clinical trial.
Expert Video - What safeguards are in place to protect patients in clinical trials?
Physicians describe the safeguards that are put in place to protect patients in clinical trials. At the beginning, the initial idea for the study undergoes a series of reviews to make sure the study idea is appropriate, that patients will be safe, that the right drugs are being used, and the right end points are going to be answered. A big part of the safeguard process is institutional review board (IRB) oversight. An IRB is a committee that reviews the trial to ensure the science and safety aspects for patient care. Furthermore, the principal investigator has an ethical and professional obligation to both the patient and to the study. In addition, on a national level, there are federal safeguards in place that oversee clinical trials. For example, periodically, audits can be done at institutions of clinical trials to make sure there isn't an important safety signal being missed to make sure that the data is reported accurately and in a timely fashion.
Expert Video - What happens if a patient change’s their mind and wants to leave a clinical trial?
Physicians discuss what happens if a patient changes their mind and wants to leave a clinical trial. A patient has every right to choose to stop participating in a clinical trial at whatever time point they want, even if they don't meet formal criteria for having to be taken off the trial. A patient will be removed from a study if the treatment is not working, if their cancer is continuing to grow, if researchers observe an unacceptable level of potentially serious side effects that may be life-threatening, or if the clinical trial is affecting their quality of life too much. There are also occasions where a patient finds that a clinical trial is just too time-intensive. It’s always important for a patient to talk with the researchers about their reasons for leaving the trial and to make sure that everything is done in the safest manner possible.
Expert Video - Will patients know or be able to pick what medications they will be receiving when they are in a clinical trial?
Physicians discuss whether patients will be able to pick what medications they will be receiving in a clinical trial. Every clinical trial is different, and sometimes this is possible and sometimes it is not. Sometimes one group of patients will want to choose one option and another group will want the opposite choice. Sometimes a “randomized” trial will be in place, where neither the patient nor the physician can choose which medication the patient will receive. The process of randomization is typically coordinated by computer allocation so that there is no bias in the study design. Randomization can make the results more accurate and more reliable.
Expert Video - What is a “Placebo” in a clinical trial and is it always used?
Physicians discuss what a “placebo” is in a clinical trial, and if is it always used. Placebos can have some real impacts on a clinical trial. Researchers know that there is an effect from the trial, but they need to isolate that effect to make sure it is really the medicine or device that is causing that effect. In some clinical trials, doctors want to learn if adding a new drug to the standard therapy makes it work better. In these studies, some patients get the standard drug(s) and the new one being tested, while other patients get the standard drug(s) and a placebo. But none of the patients would get only a placebo. The placebo may look like medicine but it has no active ingredient in it. This clinical trial context is typically “blinded”, meaning neither the doctors nor the patients know which group they are in. This ensures there are no doctor or patient biases that impact the outcomes of the clinical trial.
Expert Video - How will I find out about the results of a clinical trial and will my information be kept confidential?
Physicians discuss how patients can find out the results of a clinical trial that they participated in, how results for the larger group of patients are announced, and that individual patient information is always kept confidential. Clinical trial results can be made available to the general public and patients in a number of ways, such as at big scientific meetings, or in journal publications. The goal is to let as many people know as possible and to enhance knowledge sharing amongst the oncology research community to stimulate further ideas and clinical trials. Announcing results often happens when clinical trials are completed and an update will be put on the clinicaltrials.gov website. Occasionally a study will reach an end point and researchers may have to close the study early. As for patient privacy, patients will sign a disclosure that acknowledges that the study team looking after them will have access to their information, however individual information is never shared outside the trial without patient consent. Often the institutional review board (IRB) will have oversight, as well as the company or agency that's funding the trial. The Federal Drug Authority (FDA) can also have access to the information, as well as certain collaborating sites if they are involved in the clinical trial. All of this information should be provided up front to patients and is part of the informed consent process. There are many safety measures in place to protect confidential (also called “Privileged”) information as much as possible.
Expert Video - What does “randomized” and “standard of care arm” and “experimental arm” mean in a clinical trial?
Physicians explain what randomization, standard of care arm and experimental arm mean in clinical trial study design. Randomization is where participants are assigned by chance to separate groups that compare different treatments, and neither the participant, nor the doctor, nor the medical team can choose which group the participant is assigned to. Typically this is assigned by computer allocation. They also explain that to help support the development of new drugs there needs to be a reference, and that reference is called a standard approach or ‘standard of care.’ Participants may be assigned to the standard of care arm of a study where they receive the standard of care treatment plus placebo, or to the experimental arm where they receive the standard of care plus the new treatment of interest. If a study design is ‘blinded’ it means that one or more parties involved in the trial (such as the participant, or researchers, or sometimes both) do not know which study arm the participant is assigned to.
Module: Endoscopic Procedures
Expert Video - What is endoscopy?
In this video, physicians explain that endoscopy is a medical procedure that uses an instrument called an endoscope to examine an area of the body, such as the gastrointestinal (GI) tract. They describe the different types of endoscopic procedures that may be used, depending on what is being examined: upper endoscopy (esophagogastroduodenoscopy, or EGD), push enteroscopy, deep endoscopy, and also advanced endoscopic procedures such as Endoscopic ultrasound (EUS) and Endoscopic Retrograde Cholangiopancreatography (ERCP).
Expert Video - What is ERCP?
Expert physicians discuss Endoscopic Retrograde Cholangiopancreatography (ERCP), which is an upper gastrointestinal (GI) endoscopic procedure used to treat problems of the pancreatic or bile duct. The physicians emphasize that ERCP is used for therapeutic purposes, such as removing stones, placing stents, bypassing obstructions, and more. ERCP helps your doctor make critical decisions concerning your health.
Expert Video - When is ERCP used?
Physicians discuss how ERCP is used as a therapeutic procedure when patient complaints or laboratory findings indicate problems in the bile and pancreatic duct. It is commonly used to bypass obstructions or remove stones, but is also used to remove or treat tumors, infections, inflammation, scarring, fluid or tissue debris. ERCP is generally performed as an outpatient procedure, but can also be performed when the patient is in the hospital for an emergency problem, for example in cases of cholangitis or gallstone pancreatitits.
Expert Video - How should patients prepare for an ERCP?
Pancreatic disease specialists discuss how patients should best prepare for an ERCP procedure and what to expect, including no eating or drinking before ERCP, a thorough understanding of the patient’s medical history, and restriction of certain medications. This will be determined by your doctor. They emphasize the importance of communication between the patient, specialist and primary care provider as part of the preparation plan, so that everybody involved has complete understanding of what is expected going into the procedure.
Expert Video - What follow-up care is required after an ERCP?
Physicians discuss the specific details and type of follow-up care that is required after an ERCP procedure, in both the inpatient and outpatient setting. They discuss potential problems to look out for after and ERCP, and the importance of follow-up communication with your doctor.
Expert Video - How is an ERCP performed?
Physicians describe how the ERCP procedure is performed and the various steps involved, including the scope, camera, x-ray as well as the devices and tools used to examine and treat the pancreatic or bile duct problem. They emphasize that ERCP is an advanced endoscopic procedure that should be performed by well-trained and experienced physicians. They encourage patients to ask their doctor about how much experience they have had performing ERCP.
Expert Video - What are the risks of ERCP?
Pancreatic disease specialists talk about how ERCP is more invasive than routine endoscopic procedures, and that ERCP carries risks of complications, depending on individual patient factors. They discuss risks such as inflammation or pancreatitis, bleeding, infection, perforation. They also describe the techniques they use to minimize these risks.
Expert Video - What are the benefits of ERCP?
Physicians discuss the benefits of ERCP and what patients can expect depending on individual patient factors. ERCP can either completely solve a patient's pancreatic problem and alleviate symptoms (such as pain, obstructions, stones and more), or ERCP can indicate the need for further therapeutic interventions. Importantly, ERCP can reduce the risk of other and more serious complications down the line.
Expert Video - What is Endoscopic Ultrasound-Guided Fine-Needle Aspiration (EUS-FNA)?
Expert physicians describe Endoscopic Ultrasound-Guided Fine-Needle Aspiration (EUS-FNA), which is a specialized gastrointestinal endoscopic procedure that uses ultrasound imaging of the digestive tract (including the pancreas and surrounding abdominal structures) and biopsy via fine-needle aspiration to allow your doctor to sample areas of interest for analysis. Patients may be referred for an EUS for several reasons that include: evaluation of pancreatic lesions or tumors; further evaluation of cystic lesions of the pancreas; and in patients with suspected, or established, chronic pancreatitis.
Expert Video - When is EUS-FNA used?
Physicians discuss the indications for EUS-FNA, namely investigating abnormal findings from prior exams and tests, evaluating masses, tumors, lesions and abnormalities of the gastrointestinal (GI) tract, staging of cancers, and more. The findings from the EUS-FNA test are helpful to surgeons and oncologists, to assess and determine what the next step of treatment will be for the patient.
Expert Video - How should patients prepare for an EUS-FNA?
Pancreatic disease specialists discuss how patients should prepare for an EUS-FNA procedure and what to expect. Patients should not eat or drink for 8 hours before the procedure. Certain medications may be restricted so it is important to tell your doctor what medications you are currently taking. Before you are discharged from the hospital, you must make arrangements with a family member or a close friend to drive you home. The experts emphasize the importance of communication between the patient and the surgeon, so that the patient has a clear understanding of what is to be expected before, during and after the procedure.
Expert Video - What follow-up care is required after an EUS-FNA?
In this video, pancreatic disease specialists discuss the follow-up care that is required following an EUS-FNA procedure. Before being discharged home, patients will have an opportunity to meet with the physician to discuss the results of the procedure, and receive further instructions regarding medications and additional follow-up. A definitive diagnosis can take up to a week, or can be sooner depending on the circumstances. The experts also talk about some of the potential problems to look out for after an EUS-FNA, as well as the importance of calling your doctor if any troublesome complications arise.
Expert Video - What are the risks and benefits of EUS-FNA?
In this video, pancreatic disease specialists discuss the benefits and rare risks associated with EUS-FNA. The main benefit of EUS-FNA is that it is a relatively non-invasive procedure that provides a large amount of information and a specific diagnosis that has high sensitivity and high specificity. Patients and physicians should discuss the benefits and risks prior to the EUS-FNA procedure and determine what will benefit the patient the most.
Module: Nutrition and PERT
Expert Video - What are the causes and symptoms of exocrine pancreatic insufficiency (EPI)?
Physicians discuss EPI, including causes, risk factors and long-term consequences like nutrition-related diseases. They also discuss inherited conditions that are linked to EPI.
Expert Video - How is EPI diagnosed?
Physicians discuss how they diagnose EPI, including lifestyle factors and symptoms that lead them to suspect EPI, and the follow-up tests that confirm the diagnosis.
Expert Video - How is EPI treated?
Physicians discuss the approaches to treating EPI including pancreatic enzyme replacement therapy (PERT), vitamin and mineral supplementation, and dietary interventions. They also discuss when they decide to implement PERT.