Impact of qualitative endoscopic ultrasonography on fatty pancreas at a referral medical center

Abstract

Background Taking advantage of the current advances in diagnostic imaging modalities, including endoscopic ultrasonography (EUS), and due to the increased attention to ectopic fat accumulation in the pancreas following the rising trend of metabolic syndrome, we qualitatively assessed the clinical implication of pancreatic steatosis by EUS in this study. Methods The study included 243 patients that were divided into four groups. The correlation between the average echogenicity of the pancreas and that of the control organs and the key clinical data of all study patients were collectively analyzed. The cut‐off point of the pancreas‐control (PC) ratio in EUS and liver‐control (LC) ratio on abdominal ultrasound were determined from the population distribution and the obtained median values. Results With the cut‐off point of 1.30 for the PC ratio and 1.20 for the LC ratio, sex, the Brinkman index, habitual alcohol drinkers, and fatty pancreas were significant factors. The associations between each relevant factor in fatty pancreas, metabolic syndrome in the fatty liver group, and age in the pancreatic cancer group were all significant in the analysis. In addition, we investigated whether the PC ratio differed according to age and staging in pancreatic cancer patients. Interestingly, the PC ratio was lower in the advanced stage group than in the early‐stage group. Conclusion Our results suggest that, irrespective of the degree, ectopic fat infiltration in the pancreas could be a specific clinical phenotype of serious pancreatic diseases, including pancreatic cancer, especially in high‐risk patients.

Bidirectional association between non-alcoholic fatty liver disease and fatty pancreas: a systematic review and meta-analysis

“…However, the heterogeneity was explored in subgroup analyses, and the results showed consistency in all subgroups. Third, although 14 of 26 included studies adjusted for at least one potential confounder, only 11 studies adjusted for cardiometabolic risk factors, especially insulin resistance, diabetes mellitus, and obesity [10][11][12]16,17,21,23,24,29,31,32]. It is conceivable that the association between fatty pancreas and NAFLD may be a result of confounders.…”

“…The meta-analysis of the 19 included studies [11,12,[14][15][16][17]19,[21][22][23][24]26,[29][30][31][32][33]41,42] is presented in Fig. 2.…”

“…Subsequently, 85 articles underwent the second round of review. Finally, 26 observational studies comprising a total of 67 803 patients were included in the analysis: 4 case-control studies and 22 cross-sectional studies [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]26,[28][29][30][31][32][33][34]41,42]. No longitudinal cohort studies reporting the outcomes of interest were identified.…”

“…Of the 26 articles, 24 were full-text articles, and two were conference abstracts. Nineteen studies, involving a total of 52 723 subjects, reported the odds of fatty pancreas in patients with and without NAFLD [11,12,[14][15][16][17]19,[21][22][23][24]26,[29][30][31][32][33]41,42]. Three articles, with a total of 802 patients, evaluated the odds of NAFLD in patients with and without fatty pancreas [13,28,34].…”

“…Age, sex, ethnicity, unhealthy lifestyle, and metabolic disorders have been recognized as the common risk factors for fatty pancreas [3,7,9]. Growing evidence has shown associations between fat content in the pancreas and the liver, suggesting a potential relationship between fatty pancreas and NAFLD [10–34]. Some research has discovered evidence that fatty pancreas contributes to fat accumulation in the liver, potentially accelerating the progression of NAFLD [18].…”