Risk Factors for Hyperechogenic Pancreas on Endoscopic Ultrasound

Al‐Haddad, Mohammad; Khashab, Mouen A.; Zyromski, Nicholas J.; Pungpapong, Surakit; Wallace, Michael B.; Scolapio, James S.; Woodward, Timothy A.; Noh, Kyung W.; Raimondo, Massimo

doi:10.1097/mpa.0b013e3181a9d5af

Cited by 111 publications

(126 citation statements)

References 35 publications

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“…The radiological assessment of fatty pancreas remains challenging. However, some studies have succeeded in quantifying fatty pancreas using similar methods and modalities as those used in assessing the liver [19,26,27] . Fatty infiltration of an organ is observed as a decrease in CT attenuation [28,29] .…”

Section: Discussionmentioning

confidence: 99%

Risk Factor of Pancreatic Fistula after Radical Gastrectomy from the Viewpoint of Fatty Pancreas

Sato¹,

Inokuchi²,

Otsuki³

et al. 2017

Dig Surg

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Background: We suspected that fatty pancreas, accompanied with metabolic syndrome, may be associated with the incidence of postoperative pancreatic fistula (POPF) after radial gastrectomy. Methods: Between February 2012 and March 2014, we reviewed consecutive 79 gastric cancer patients who underwent radical gastrectomy. To quantify the degree of fatty infiltration to pancreas by preoperative contrast-enhanced CT, we measured ratios and differences between pancreatic and splenic attenuation values (P/S and P-S, respectively). The optimal cut-off values of P/S and P-S for predicting POPF were determined using the receiver operating characteristic (ROC) curve analysis. Risk factors for POPF of International Study Group on Pancreatic Fistula grade B or higher were examined using univariate and multivariate analyses. Results: POPF occurred in 6 patients (7.6%). ROC curve analyses revealed that the most optimal predictive values of P/S and P-S were 0.74 and -28.8, respectively. Univariate analysis demonstrated that high visceral fat area (p = 0.037), low P/S (p = 0.013), and low P-S (p = 0.006) were significant risk factors of POPF. Multivariate analysis demonstrated that low P/S (OR 10.2 [p = 0.046]) and low P-S (OR 13.2 [p = 0.023]) were significant risk factors of POPF. Conclusion: Fatty pancreas is a risk factor of POPF after radical gastrectomy.

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Section: Discussionmentioning

confidence: 99%

Risk Factor of Pancreatic Fistula after Radical Gastrectomy from the Viewpoint of Fatty Pancreas

Sato¹,

Inokuchi²,

Otsuki³

et al. 2017

Dig Surg

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“…They used the increase echogenicity of the pancreatic body over kidney echogenicity as the index of a fatty pancreas, and they found that a fatty pancreas is related only to the metabolic syndrome. These data were also confirmed using an endoscopic ultrasonography in a study comprising 60 patients and 60 controls [11] ; in this latter study, hepatic steatosis, alcohol use and an increased BMI were predictors of pancreatic steatosis fat [11] . In one study, the pancreatic volume from birth to advanced age (100 years old) was evaluated in a retrospective study [12] ; the authors studied by computed tomography 133 subjects with under 20 years of age, 1721 adults over 20 years of age and 165 patients having type-2 diabetes, and in these patients, the fat within the pancreatic gland was also evaluated.…”

Section: Imaging Aspects Of Exocrine Pancreatic Steatosis: the Era Ofmentioning

confidence: 58%

Pancreatic steatosis: Is it related to either obesity or diabetes mellitus?

Pezzilli¹

2014

WJD

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The accumulation of fat in the pancreatic gland has been referred to using various synonyms, such as pancreatic lipomatosis, fatty replacement, fatty infiltration, fatty pancreas, lipomatous pseudohypertrophy, non-alcoholic fatty pancreatic disease and pancreatic steatosis We believe that pancreatic steatosis is the best description of fat accumulation in the pancreatic gland without fat replacement, and this term also describes the possibility that the fat accumulation is a reversible process. A review of the existing literature was carried out, and it was found that there was notable evidence from both the pathological and the imaging point of view that pancreatic steatosis is an increasing problem due to the increasing incidence of obesity. The conclusion was that pancreatic steatosis was easily detectable using modern imaging techniques, such as ultrasonography, endoscopic ultrasonography, computed tomography and magnetic resonance imaging. Pancreatic steatosis was not due to the presence of diabetes mellitus but was highly associated with the metabolic syndrome. The possible presence of steatopancreatitis should be better evaluated, especially regarding the inflammatory cascade, and additional studies are needed which are capable of assessing whether non-alcoholic steatopancreatitis really exists as does non-alcoholic steatohepatitis. Finally, the presence of exocrine pancreatic function should be extensively evaluated in patients with pancreatic steatosis. Key words: Computed tomography; Endoscopic ultrasonography; Magnetic resonance imaging; Metabolic syndrome; Pancreatic steatosis; Pathology; Type 2 diabetes mellitus; Ultrasonography Core tip: Pancreatic steatosis is easily detectable using modern imaging techniques, such as ultrasonography, endoscopic ultrasonography, computed tomography and magnetic resonance imaging. It is not due to the presence of diabetes mellitus but is highly associated with the metabolic syndrome. The possible presence of steatopancreatitis should be better evaluated, especially regarding the inflammatory cascade, and additional studies are needed which are capable of assessing whether non-alcoholic steatopancreatitis really exists as does non-alcoholic steatohepatitis. Additional studies regarding the exocrine pancreatic function in patients with pancreatic steatosis are needed.

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“…Second, pancreatic EUS findings that mimic CP are often seen as a result of normal aging, male sex, tobacco use, obesity, or alcohol use. [75][76][77][78] Third, although some studies have demonstrated good interobserver agreement among expert endosonographers for suspected CP, others have demonstrated relatively poor interobserver agreement. 74,79 Fourth, in contrast to AIP, data are insufficient to endorse the use of EUS-guided tissue acquisition for diagnosing CP at the present time.…”

Section: Endoscopic Diagnosis Of Cpmentioning

confidence: 95%