A prospective pancreatographic study of the prevalence of pancreatic carcinoma in patients with diabetes mellitus.
BACKGROUND
The correlation between diabetes mellitus and pancreatic carcinoma is well documented, but no criteria have been established for the efficient selection of a high-risk group among patients with diabetes mellitus.


METHODS
Eighty-seven patients were selected prospectively from outpatients with diabetes and underwent endoscopic retrograde pancreatography (ERP) according to the authors' original criteria, including the onset of diabetes after age 55 years, deterioration of diabetes or loss of body weight despite strict medical control, elevation of serum amylase and/or CA19-9 levels, and pancreatobiliary abnormalities on routine ultrasonography. The patients were divided into two groups according to the time from the onset of diabetes to ERP: Patients in Group A had recent-onset diabetes (within 3 years), and Group B patients had diabetes for > 3 years.


RESULTS
A total of 86 patients (excluding 1 patient with unsuccessful ERP who had undergone previous Billroth-2 gastrectomy) were enrolled. There were 33 males and 53 females, age 40-90 years, with a mean age of 65.1 years. ERP demonstrated pancreatic carcinoma, although it was advanced disease in all patients, at an extremely high rate of 7.0% (6 of 86 patients) with no serious complications. The prevalence of pancreatic carcinoma in Group A (13.9%; 5 of 36 patients) was significantly greater compared with Group B (2.0%; 1 of 50 patients; P = 0.0442). ERP with an indwelling balloon catheter and subsequent pancreatic juice sampling was performed in 49 patients, yielding positive cytology in 1 patient with pancreatic tail carcinoma, whereas measurements of carcinoembryonic antigen and CA19-9 levels in pancreatic juice were of no use in the diagnosis of pancreatic carcinoma.


CONCLUSIONS
Selective ERP in patients with diabetes who were at high risk did not lead to the early diagnosis of pancreatic carcinoma, although this study showed that the 3-year period after the onset of diabetes was critical. A more aggressive diagnostic approach within this period in diabetic patients with the authors' criteria may contribute to the earlier diagnosis of pancreatic carcinoma.
Ogawa
Yoshiaki
Y
Department of Surgery, Kitakyushu Municipal Medical Center, Fukuoka, Japan.
Tanaka
Masao
M
Inoue
Ken
K
Yamaguchi
Koji
K
Chijiiwa
Kazuo
K
Mizumoto
Kazuhiro
K
Tsutsu
Nobutaka
N
Nakamura
Yoshihiro
Y
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000097:blood; D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen / Q000032:analysis; D002760:Cholangiopancreatography, Endoscopic Retrograde; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging*; D010189:Pancreatic Juice / Q000737:chemistry; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging* / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D014463:Ultrasonography; D015431:Weight Loss
D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen; D000681:Amylases