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Endoscopic Ultrasound Finding of Diffuse Echogenicity in the Pancreas, Is It Relevant?

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Abstract

Background/Objectives

Diffuse echogenicity of the pancreas, a commonly discovered finding on endoscopic ultrasound (EUS), is often of undetermined significance. The goal of this study was to characterize the clinical picture and pancreatic function in patients who incidentally present with this endosonographic finding.

Methods

This was a case–control study comparing consecutive adult patients with diffuse echogenicity of the pancreas found on EUS to those who did not have known pancreas disease. Demographic and clinical data were extracted from the electronic medical record. The primary endpoint was exocrine pancreatic insufficiency (EPI) defined as fecal elastase (FE-1) < 200 μg/g.

Results

A total of 166 patients were included in this study. There were 89 patients who had diffuse echogenicity of the pancreas on EUS and FE-1 testing. There were 77 control patients with chronic diarrhea who did not have known pancreas disease but did have FE-1 testing. EPI was significantly more likely in the fatty pancreas group compared to the control group (47% vs 6%, p < 0.001). There was also a significantly greater proportion of smokers in the fatty pancreas group compared to the control group (42% vs 17%, p = 0.002). There were no other differences in baseline characteristics between the two groups, including prevalence of chronic pancreatitis by Rosemont classification. On multiple logistic regression analysis controlling for multiple variables, smoking (OR 2.26, 95% CI 1.15–4.43) and NAFLD (OR 3.99, 95% CI 1.09–14.70) had significant associations with EPI.

Conclusions

This study found a significantly greater amount of patients who had diffuse echogenicity of the pancreas on EUS to also have EPI. This is compared to a control group of patients without known pancreas disease. This prevalence was found in the absence of a significant association with chronic pancreatitis on EUS based on Rosemont classification. Future controlled studies are required to further investigate this relationship.

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Authors and Affiliations

  1. Division of Gastroenterology, Baylor College of Medicine, Houston, TX, USA

    Joseph T. Krill, Mohammed S. Hussein, Kalpesh Patel, Hashem B. El Serag & Mohamed O. Othman

  2. Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA

    David Szafron

  3. Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ, USA

    Sherif Elhanafi

  4. Department of Internal Medicine, Al-Azhar University, Cairo, Egypt

    Mohammed S. Hussein

  5. Greater Houston Gastroenterology, Houston, TX, USA

    Isaac Raijman

  6. Department of General Surgery, Baylor College of Medicine, Houston, TX, USA

    William Fisher

  7. Chief of Gastroenterology Section, Baylor St Luke’s Medical Center, 7200 Cambridge St. STE 10C, Houston, TX, 77030, USA

    Mohamed O. Othman

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  1. Joseph T. Krill
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Corresponding author

Correspondence to Mohamed O. Othman.

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Conflict of interest

Mohamed O Othman is a consultant for Abbvie, Conmed, Olympus, Boston Scientific Corporation, Apollo and Nestle. Mohamed O Othman recieved research grant from Abbvie, Conmed, Kangen Pharmaceutical and Lucid Diagnostics. Isaac Raijman is a consultant for Boston Scientific Corporation and Conmed. Other authors have no conflict of interest.

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Krill, J.T., Szafron, D., Elhanafi, S. et al. Endoscopic Ultrasound Finding of Diffuse Echogenicity in the Pancreas, Is It Relevant?. Dig Dis Sci 67, 3244–3251 (2022). https://doi.org/10.1007/s10620-021-07181-1

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  • DOI: https://doi.org/10.1007/s10620-021-07181-1

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