P0052 - Patterns of Fatty Infiltration in Pancreas on Endoscopic Ultrasound: A Novel Classification System

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Has Audio

Presenting Author(s)

TK

Tara Keihanian, MD

Baylor College of Medicine
Houston, TX

Tara Keihanian, MD, Salmaan A. Jawaid, MD, Wasif Abidi, MD, Waqer Qureshi, MD, Mohamed O. Othman, MD
Baylor College of Medicine, Houston, TX

Introduction: Fatty pancreas (FP) was proven to have long-term consequences such as diabetes, chronic pancreatitis and pancreatic malignancy. Diffuse echogenicity of the pancreas is hallmark of endoscopic ultrasound (EUS) diagnosis of FP. However, distribution of diffuse echogenicity on EUS is not uniform. The main aim of this study is to investigate the different patterns of FP on EUS and propose a new classification system based on commonly seen patterns of FP on EUS exam.

Methods: This is a retrospective single-center study of all patients who were diagnosed with FP on EUS at a tertiary center in the United States from Jan 2015 till June 2022. After independent review of the EUS images by two endosonographers, the consensus was made to divide FP distribution into 3 types: I. Diffuse echogenicity of the entire pancreas with discrete hypoechoic areas” indicative of fatty sparing areas”, II. Uniform diffuse echogenicity of the entire pancreas without any hypoechoic areas of fat sparring and III. Diffuse echogenicity of the entire pancreas extending beyond the pancreatic border, “Cotton candy appearance”. Each category was subdivided into A and B, corresponding to absence and presence of additional pancreatic parenchymal changes, respectively.

Results: Overall, 238 patients were included (69.7% female). The average age of patients was 57.45 ± 12.93 years old. The mean body mass index (BMI) was 31.27 ± 6.9 kg/m². Concurrent diabetes and fatty liver were noted in 26.9% and 24.7% of the patients, respectively. The incidence of exocrine pancreatic insufficiency (EPI) in those who underwent testing (n=68) was 33.8%. Diffuse echogenicity of the pancreas without any hypoechoic areas “type II“ was the most observed type in our cohort (44.1%). Type I and type III were seen in 26.1% and 29.8% of the cohort, respectively. In subgroup analysis, there was no statistically significant difference in age, gender, history of tobacco or alcohol use between the three types. The three types of FP had similar clinical patterns. For example, there was similar incidence of diabetes (p=0.9), fatty liver (p=0.9) and EPI (p=0.4) within the three types of FP.

Discussion: Fatty Pancreas can present with different patterns on EUS imaging. Awareness of the various patterns of distribution of fatty pancreas is essential to ensure proper diagnosis is made.

Figure: EUS appearance of different subtypes of FP

	N=238
Gender (Female)	69.7% (n=166)
Age	57.45 ± 12.93
Weight	87.92 ± 21.36
BMI	31.27 ± 6.9
Tobacco use Current smoker Former smoker Never smoker	9.7% (n=23) 35.3% (n=84) 54.6% (n=130)
EtoH intake Current use Former use Never user	33.2% (n=79) 17.2% (n=41) 49.2% (n=117)
History of Diabetes	26.9% (n=64)
History of fatty liver (available in 174) Fatty liver on US Fatty liver on CT scan Fatty liver on MRI	24.7% (n=43) 9.3% (n=4) 58.1% (n=25) 32.5% (n=14)
Diagnosis of EPI (Available in 68)	33.8% (n=23)
Indication of EUS Abdominal pain Abnormal EGD Abnormal CT/MRI of abdomen Acute recurrent pancreatitis Suspected EPI Suspected chronic pancreatitis Surveillance of gastric varices Weight loss Abnormal LFT	13.9% (n=33) 3.8% (n=9) 35.7% (n=85) 6.3% (n=15) 2.5% (n=6) 23.9% (n=57) 1.3% (n=3) 2.1% (n=5) 1.7% (n=4)
Classification 1 2 3	26.1% (n=62) 44.1% (n=105) 29.8% (n=71)
Patient with/without Parenchymal changes in each subtype 1A 1B 2A 2B 3A 3B	1.7% (n=4) 24.4% (n=58) 7.1% (n=17) 37% (n=88) 5.9% (n=14) 23.9% (n=57)
Fatty pancreas on CT or MRI (n=171) Fatty pancreas on CT scan (n=107) Fatty pancreas on MRI (n=64)	5.85 (n=10) 5.61% (n=6) 6.25% (n=4)

Table: Baseline patient characteristics and EUS findings

Disclosures:

Tara Keihanian: ConMed – Consultant. Lumendi – Consultant. Neptune Medical – Consultant.

Salmaan Jawaid: Boston Scientific – Consultant. ConMed – Consultant. CREO Speedboat – Consultant. DiLumen – Consultant.

Wasif Abidi: Ambu – Consultant. Apollo Endosurgery – Consultant. ConMed – Consultant.

Waqer Qureshi indicated no relevant financial relationships.

Mohamed Othman: AbbVie Inc. – Consultant, Grant/Research Support. Apollo – Consultant. Boston Scientific Coporation – Consultant, Grant/Research Support. ConMed – Consultant, Grant/Research Support. Creo Medical – Consultant. Lucid Diagnostics – Grant/Research Support. Lumendi – Consultant. Olympus – Consultant.

Tara Keihanian, MD, Salmaan A. Jawaid, MD, Wasif Abidi, MD, Waqer Qureshi, MD, Mohamed O. Othman, MD. P0052 - Patterns of Fatty Infiltration in Pancreas on Endoscopic Ultrasound: A Novel Classification System, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.