Evolution of features of chronic pancreatitis during endoscopic ultrasound-based surveillance of individuals at high risk for pancreatic cancer

Abstract

Background and study aims During endoscopic ultrasound (EUS)-based pancreatic ductal adenocarcinoma (PDAC)-surveillance in asymptomatic individuals, features of chronic pancreatitis (CP) are often detected. Little is known about the prevalence and progression of these features. The aim of this study was to quantify these features, assess the interobserver agreement, assess possible associated factors, and assess the natural course during 3 years of follow-up. Patients and methods Two experienced endosonographers reviewed anonymized sequential EUS videos of participants in PDAC surveillance that were obtained in 2012 and 2015 for features of CP. Descriptives, agreement analyses, univariate and multivariate analyses for possible risk factors, and repeated measures analyses to assess intra-individual changes over time were performed. Results A total of 42 EUS videos of 21 participants were reviewed. Any feature of CP was present in 86 % (2012) and 81 % (2015) of participants, with a mean of 2.5 features per individual. The overall interobserver agreement was almost perfect at 83 %. No baseline factors were significantly associated with features of CP. Features did not change over time, except for hyperechoic foci without shadowing, which decreased intra-individually (β = – 1.6, P = 0.005). Conclusions This blinded study shows features of CP to be highly prevalent in individuals at high risk of developing pancreatic cancer. No baseline factors were associated with presence of these features. CP features did not increase intra-individually over a 3-year period. Longer follow-up and pathological examination of pancreatic resection specimens will be essential to learn whether EUS detection and follow-up of these CP features bear clinical relevance.

Recommendations for a More Organized and Effective Approach to the Early Detection of Pancreatic Cancer From the PRECEDE (Pancreatic Cancer Early Detection) Consortium

“…However, in only a minority of patients are these findings identified, and our current understanding of evolution of pancreatic precursors suggests that more subtle findings, such as parenchymal changes, can be important to recognize precursors. 28,29 Most of these parenchymal changes were initially described in relation to chronic pancreatitis-associated changes, but have since been associated with changes observed in neoplastic progression. 28,30 Improved resolution of B-mode EUS imaging and enhanced imaging modalities (ie, elastography and contrast enhancement) will likely further improve our ability to characterize parenchymal changes associated with early neoplastic development.…”

“…28,29 Most of these parenchymal changes were initially described in relation to chronic pancreatitis-associated changes, but have since been associated with changes observed in neoplastic progression. 28,30 Improved resolution of B-mode EUS imaging and enhanced imaging modalities (ie, elastography and contrast enhancement) will likely further improve our ability to characterize parenchymal changes associated with early neoplastic development. An obvious parallel to draw on is the unequivocal benefit of high-resolution white light and virtual chromoendoscopy in detection of gastric and colonic neoplasia in luminal imaging.…”

Role of endoscopic ultrasound in the screening and follow-up of high-risk individuals for familial pancreatic cancer

“…The supposed explanation is that multifocal PanIN lesions produce obstructive lobular atrophy, which is probably the source of CPis[53]. Features of chronic pancreatitis during EUS-based surveillance of HRI are easily seen with good interobserver agreement[48]. One study showed that CPis generally have no or little progression over time, although the follow-up period was limited (3 years)[48].…”

“…Features of chronic pancreatitis during EUS-based surveillance of HRI are easily seen with good interobserver agreement[48]. One study showed that CPis generally have no or little progression over time, although the follow-up period was limited (3 years)[48]. A fatty pancreas has also been reported to be a risk factor for PC and should be noted on the EUS report[55].…”

“…Overall, pancreatic screening may have a positive psychological impact on HRI[76]. Konings et al[48] reported a low psychological burden due to the examinations themselves, which were considered uncomfortable only in 10% of cases. Of note, although it is an invasive procedure, EUS was generally not considered to be more uncomfortable than MRI[48,76].…”