Chronic pancreatitis changes in high-risk individuals for pancreatic ductal adenocarcinoma. Gastrointestinal endoscopy Thiruvengadam, S. S., Chuang, J., Huang, R., Girotra, M., Park, W. G. 2018


BACKGROUND AND AIMS: Pancreatic intraepithelial neoplasia is associated with chronic pancreatitis (CP) changes on EUS. The objective of this study was to determine whether CP changes were more common in high-risk individuals (HRIs) than in controls and whether these changes differed among higher-risk subsets of HRIs.METHODS: HRIs and controls were identified from an endoscopy database. HRIs were defined as having predisposing mutations or a family history (FH) of pancreatic ductal adenocarcinoma. HRIs were classified as vHRIs who met cancer of the pancreas screening (CAPS) criteria for high risk and mHRIs who did not. Multivariable logistic regression was used to adjust for confounders and CP risk factors.RESULTS: 65 HRIs (44 vHRIs, 21 mHRIs) and 118 controls were included. HRIs were included for FH (25), Lynch syndrome (5), Peutz-Jeghers syndrome (2), and mutations in BRCA1/2 (26), PALB2 (3), ATM (3), and CDKN2A (1). After adjustment for relevant variables, HRIs were 16 times more likely to exhibit 3 or more CP changes than controls (95% CI, 2.6-97.0; P = .003). HRIs were also more likely to have hypoechoic foci (OR, 8.0; 95% CI, 1.9-32.9; P = .004). vHRIs and mHRIs did not differ in frequency of three or more CP changes on EUS.CONCLUSIONS: HRIs were more likely to exhibit CP changes and hypoechoic foci on EUS compared with controls. HRIs with these findings may require closer surveillance. HRIs who did or did not meet CAPS criteria did not differ with regard to CP findings, supporting a more inclusive approach to screening.

View details for DOI 10.1016/j.gie.2018.08.029

View details for PubMedID 30145314