A0012 - Dynamic Pancreatic Parenchymal Changes in the Setting of Fatty Pancreas: A Short-Term Follow-Up Study

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Has Audio

Presenting Author(s)

Abdullah A. Muftah, MD

Baylor College of Medicine
Houston, Texas

Abdullah A. Muftah, MD, Robert L. Pecha, MD, Margarita Riojas Barrett, , Wasif Abidi, MD, PhD, Kalpesh K. Patel, MD, Tara Keihanian, MD, Mohamed Othman, MD
Baylor College of Medicine, Houston, TX

Introduction: Clinical significance and long-term impacts of Fatty pancreas (FP) on pancreatic parenchyma are not well-recognized. The aim of this study is to assess parenchymal alterations over time in patients with FP.

Methods: This is a retrospective study (2014-2021) of patients with diffuse echogenicity of the pancreas, suggestive of FP, on endoscopic ultrasound (EUS). Subjects with subsequent EUS, Magnetic Resonance Imaging (MRI), or Computed Tomography (CT) scan at least two years after the initial EUS were included. Incidence of parenchymal changes and development of chronic pancreatitis (CP) overtime were recorded.

Results: A total of 39 patients with a mean age of 51.24 ± 12.31 years were enrolled. Mean initial weight was 80.17±17.75kg. Diabetes mellitus (DM), fatty liver, and exocrine pancreatic insufficiency (EPI) were present in 15%, 46% and 33% of the patients at baseline, respectively. Patients were followed by EUS (n=25), CT scan (n=9), and MRI (n=5) over an average follow up period of 2.38 ± 0.94 years. In 25 patients with available follow up EUS, 16% (n=4) progressed to CP and 24% (n=6) had additional parenchymal changes without meeting the criteria for CP. Only one patient from the latter group developed new onset DM during the follow up period. No major parenchymal changes were noted in 52% (n=13). Of the two remaining patients, one had progressed to diffuse echogenicity of the entire pancreas rather than the body alone, while the other patient was noted to have resolution of FP with minimal hyperechoic strands after weight loss. Average weight was statistically higher at baseline and follow-up in patients with progressive parenchymal changes (92.6 ± 5.2 kg[baseline] and 96.2± 6.09 kg [follow-up]) in comparison to those with stable parenchymal appearance (78.43 ± 4.6 kg [baseline] and 82.17 ± 4.4 kg [follow-up]); p-value 0.032. In multivariate analysis, progressive parenchymal changes on EUS were associated with an increase in weight over time, independent of the effects of gender, alcohol, or tobacco (p-value = 0.04).

Discussion: Progressive parenchymal changes was noted in 44%. FP is a potential precursor for chronic pancreatitis and further parenchymal changes. Weight gain may be an independent contributor to the development of further parenchymal changes in patients with FP. Our results suggest that FP is a dynamic process with the possibility of progression or regression over time.

Figure: Figure 1- Trend of weight overtime according to parenchymal changes

Characteristics	Total	With progressive changes (n=11)	Without progressive changes (n=14)	p-value
Age (Mean ± SD) years	51.21 ± 12.34	44.7 ± 13.68	54.67 ± 10.6	0.99
Gender (female)	64% (n=25)	72.7% (n=8)	64.3% (n=9)	1.00
Race (White)	97%
Ethnicity (Non-Hispanic Latino)	74.4%
History of alcohol use	51.3% (n=20)**
*Tobacco use* Never smoker Current smoker Former smoker	12.8% (n=5)*** 28.2% (n=11)	63.6% (n=7) 36.4% (n=4) 0%	57.1% (n=8) 28.6% (n=4) 14.3% (n=2)	0.42
Baseline weight (Kg)	80.17±17.75	92.6 ± 5.2 96.2± 6.09	78.43 ± 4.6 82.17 ± 4.4	0.032
Baseline BMI (kg/m²)	29.59 ± 6.45
*Location of Fatty Infiltration* Diffuse Body and tail	92.3% (n=36) 7.7% (n=3)
*Parenchymal Changes at baseline* Hyperechoic strands Hyperechoic foci Visible side branches Dilated pancreatic duct Lobularity Atrophy Cyst Irregular duct wall Hyperechoic duct wall	64.1% (n=25) 38.5% (n=15) 17.9% (n=7) 15.4% (n=6) 10.3% (n=4) 5.1% (n=2) 5.1% (n=2) 2.6% (n=1) 2.6% (n=1)
Fatty liver Baseline Follow up	46.15% (n=18)	72.7% (n=8) 72.7% (n=8)	28.6% (n=4) 21.4% (n=3)	0.047 0.015
Diabetes mellitus Baseline Follow up	15.38% (n=6)	36.4% (n=4) 45.5% (n=5)	0% 0%	0.026 0.009
Exocrine pancreatic insufficiency	33.33% (n=13)	71.4% (n=5 out 7 with available results)	71.4% (n=5 out 7 with available results)

Table: ** Of the nineteen patients without history of alcohol use at the time on index EUS, three patients reported remote history of ethanol consumption.
*** All five patients successfully quit tobacco consumption by the time of the follow up imaging modality.

Disclosures:

Abdullah Muftah indicated no relevant financial relationships.

Robert Pecha indicated no relevant financial relationships.

Margarita Riojas Barrett indicated no relevant financial relationships.

Wasif Abidi: Ambu USA – Consultant. Apollo Endosurgery – Consultant. ConMEd – Consultant. GI dynamics – Grant/Research Support.

Kalpesh Patel: Boston Scientific – Consultant.

Tara Keihanian indicated no relevant financial relationships.

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

Abdullah A. Muftah, MD, Robert L. Pecha, MD, Margarita Riojas Barrett, , Wasif Abidi, MD, PhD, Kalpesh K. Patel, MD, Tara Keihanian, MD, Mohamed Othman, MD. A0012 - Dynamic Pancreatic Parenchymal Changes in the Setting of Fatty Pancreas: A Short-Term Follow-Up Study, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.