Chronic pancreatitis-like changes detected by endoscopic ultrasound in subjects without signs of pancreatic disease: do these indicate age-related changes, effects of xenobiotics, or early chronic pancreatitis?
OBJECTIVE
The threshold number of endoscopic ultrasound (EUS) criteria for diagnosing chronic pancreatitis (CP) is variable. The presence of more than three abnormal ductular or parenchymal features is typically used, but the diagnostic significance of fewer EUS criteria is currently unclear. The aim of this study was to determine the prevalence of EUS features of CP in patients without pancreaticobiliary disease and to analyze the association with specific factors of interest.


METHODS
Over a 24-month period, 2,614 patients underwent EUS for an indication unrelated to pancreaticobiliary disease. Main outcome measurements wereunivariate and multivariate analysis between any EUS abnormality and demographic data and habits.


RESULTS
82 patients (16.8%) showed at least one ductular or parenchymal abnormality. 38 patients presented with only one abnormal feature, 26 patients with two, 12 patients with three, 4 patients with four, and 2 patients with five. Low-level alcohol consumption significantly increased the risk of hyperechoic parenchymal foci, main pancreatic duct (MPD) dilatation and wall hyperechogenicity. Smoking was associated with an increased risk of hyperechoic parenchymal foci. Male gender and advanced age were significantly associated with an increased risk of MPD dilatation.


CONCLUSIONS
Long-term smoking and alcohol consumption, although at a low dose, induces CP-like changes. These abnormalities might represent either a clinically silent CP or a toxic effect of smoking and alcohol. Conversely, MPD dilation might represent a normal age-related variant or, alternatively, an effect of chronic low-level alcohol consumption. and IAP.
Petrone
Maria Chiara
MC
Division of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Milan, Italy. petrone.mariachiara@hsr.it
Arcidiacono
Paolo Giorgio
PG
Perri
Francesco
F
Carrara
Silvia
S
Boemo
Cinzia
C
Testoni
Pier Alberto
PA
D000328:Adult; D000368:Aged; D000375:Aging; D000428:Alcohol Drinking / Q000009:adverse effects; D019160:Endosonography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging*; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging; D050500:Pancreatitis, Chronic / Q000000981:diagnostic imaging*; D012907:Smoking / Q000009:adverse effects; D015262:Xenobiotics / Q000009:adverse effects
D015262:Xenobiotics