Non‐alcoholic fatty pancreas disease as a risk factor for pancreatic cancer based on endoscopic ultrasound examination among pancreatic cancer patients: A single‐center experience

Lesmana, C Rinaldi A; Gani, Rino Alvani; Lesmana, Laurentius A

doi:10.1002/jgh3.12032

Cited by 42 publications

(45 citation statements)

References 15 publications

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“…Obesity leads to fatty infiltration of the pancreas and an (initially reversible) defect in insulin secretion . This contributes to the risk and severity of pancreatitis and may be a risk factor for pancreatic adenocarcinoma, independent of obesity and diabetic status . The relationship between “fatty pancreas,” pancreatitis, pancreatic carcinoma, and DEP is likely multidirectional.…”

Section: Resultsmentioning

confidence: 99%

Diabetes of the exocrine pancreas

Wynne

Devereaux

Dornhorst

2018

J of Gastro and Hepatol

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Diabetes of the exocrine pancreas (DEP) is a form of diabetes that occurs due to pancreatic disease. It is far more common than has been previously considered, with a recent study showing 1.8% of adults with new-onset diabetes should have been classified as DEP. The majority is misdiagnosed as type 2 diabetes mellitus (T2DM). Patients with DEP exhibit varying degrees of exocrine and endocrine dysfunction. Damage to the islet of Langerhans effects the secretion of hormones from the β, α, and pancreatic polypeptide cells; the combination of low insulin, glucagon, and pancreatic polypeptide contributes to rapid fluctuations in glucose levels. This form of "brittle diabetes" may result in the poorer glycemic control observed in patients with DEP, when compared with those with T2DM. Diabetes of the exocrine pancreas has a different natural history to other forms of diabetes; patients are more likely to require early insulin initiation compared with those with T2DM. Therefore, individuals with DEP should be advised about the symptoms of decompensated hyperglycemia, although they are less likely to develop ketoacidosis. Clinicians should screen for DEP in patients with acute or chronic pancreatitis, following pancreatic resection, or with co-existing cystic fibrosis or hemochromatosis. Incident diabetes may herald the onset of pancreatic ductal carcinoma in a small subset of patients. Once identified, patients with DEP can benefit from specific lifestyle advice, pancreatic enzyme replacement therapy, metformin treatment, appropriate insulin dosing, and monitoring. Further research is needed to establish the ideal treatment regimens to provide optimal clinical outcomes for this unique form of diabetes.

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Section: Resultsmentioning

confidence: 99%

Diabetes of the exocrine pancreas

Wynne

Devereaux

Dornhorst

2018

J of Gastro and Hepatol

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“…При увеличении объема перипанкреатической жировой ткани увеличивается риск полиорганной недостаточности [51]. [19,30,48,66]. Различные факторы активации комплемента и белков острой фазы, ингибитор активатора плазминогена, С-реактивный белок, гаптоглобин, сывороточный амилоид А дополняют перечень секреторной активности адипоцита (рис.…”

Section: факторы рискаunclassified

“…Множество исследований случай-контроль, когортных исследований подтверждают наличие взаимосвязи между ожирением и увеличением риска развития аденокарциномы ПЖ [89]. Данное утверждение подтверждается результатами нескольких метаанализов; в одном из них показано, что стеатоз ПЖ является единственным статистически значимым фактором риска возникновения рака ПЖ (отношение шансов, ОШ 18,027; 95% ДИ 7,288-44,588) [48]. Механизм этой взаимосвязи пояснили N. Zymorski et al, связывав особенности возникновения рака ПЖ с дисбалансом адипоцитарных гормонов (рис.…”

Section: аденокарцинома пжunclassified

“…Таким образом, эндоУЗИ информативно в определении причины ВНПЖ у большинства пациентов с низким результатом фекального эластазного теста, этот метод следует широко использовать в клинической практике, т. к. он позволяет исключить прогрессирование патологического процесса и развитие рака ПЖ. По данным С. Lesmana et al, использовавших эндоУ-ЗИ для скрининга рака ПЖ на протяжении двух лет, возраст, пол, наличие СД, ХП не являются достоверными факторами риска неопластической трансформации, в отличие от стеатоза ПЖ -этот показатель оказался единственным значимым фактором, ассоциированным с высоким риском рака (ОШ 18,027; 95% ДИ 7,288-44,588) [48]. Данная группа ученых подчеркивает необходимость проведения эндоУЗИ больным НАЖБПЖ с целью раннего обнаружения рака ПЖ [48].…”

Section: Figureunclassified

“…По данным С. Lesmana et al, использовавших эндоУ-ЗИ для скрининга рака ПЖ на протяжении двух лет, возраст, пол, наличие СД, ХП не являются достоверными факторами риска неопластической трансформации, в отличие от стеатоза ПЖ -этот показатель оказался единственным значимым фактором, ассоциированным с высоким риском рака (ОШ 18,027; 95% ДИ 7,288-44,588) [48]. Данная группа ученых подчеркивает необходимость проведения эндоУЗИ больным НАЖБПЖ с целью раннего обнаружения рака ПЖ [48].…”

Section: Figureunclassified

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Parallels between non-alcoholic fatty liver disease and non-alcoholic fatty pancreatic disease: looking for points of contact or regard through the lens of metabolic syndrome

Губергриц¹,

Беляева²,

Можина³

2020

jour

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The aim. The aim of our study was to analyze the available data from literature sources concerning the issues of etiology, pathogenesis, clinic, diagnosis and features of treatment of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic fatty pancreatic disease (NAFPD).Materials and methods. We conducted a retrospective analysis of foreign literature sources that contain up-to-date information about the state of the problem of NAFLD and NAFPD.Results. NAFLD and NAFPD develop against the background of metabolic syndrome (MS), systemic insulin resistance, oxidative stress, changes in lipid metabolism. The natural course of NAFPD is associated with high risk of MS progression, occurrence of NAFLD, arterial hypertension, type 2 diabetes mellitus, exocrine pancreatic insuﬃciency, acute and chronic pancreatitis, pancreas cancer. Correction of the components of MS can reduce the severity of NAFLD and NAFPD; enzyme replacement therapy can improve the function of β-cells in pancreas steatosis.Conclusion. The alternatives of the pharmacological treatment of NAFLD and NAFPD continue to be actively explored. We emphasize the need of including medications containing pancreatic enzymes in the treatment of NAFLD.

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

et al. 2021

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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.

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Non‐alcoholic fatty pancreas disease as a risk factor for pancreatic cancer based on endoscopic ultrasound examination among pancreatic cancer patients: A single‐center experience

Cited by 42 publications

References 15 publications

Diabetes of the exocrine pancreas

Diabetes of the exocrine pancreas

Parallels between non-alcoholic fatty liver disease and non-alcoholic fatty pancreatic disease: looking for points of contact or regard through the lens of metabolic syndrome

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

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