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.
