Original Article
Age-related changes in the pancreas identified by EUS: a prospective evaluation

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Background

EUS is an important modality for the diagnosis of pancreatic disease. An understanding of normal pancreatic ductal and parenchymal variation in asymptomatic individuals is essential to improve EUS accuracy. The primary aim of this study was to determine age-related pancreatic parenchymal and ductular changes identifiable on EUS in individuals with no history or symptoms of pancreaticobiliary disease. Secondary aims were to define demographic and clinical factors associated with identifiable pancreatic parenchymal and ductular changes, and to determine the main pancreatic-duct diameter and pancreatic-gland width according to age.

Methods

Patients referred for either upper endoscopy or EUS for an indication unrelated to pancreaticobiliary disease were prospectively enrolled. Patients were stratified by age (<40, 40-60, >60 years). Each patient was assessed for the presence of EUS findings for chronic pancreatitis. Logistic regression was used to identify factors associated with an abnormality.

Results

A total of 120 patients (63 men, 57 women; median age, 52 years, interquartile range [IQR] 40-61 years) were prospectively evaluated. At least one parenchymal and/or ductular abnormality was identified in 28% of the patients, with a trend of increasing abnormality with age: <40 years (23%), 40 to 60 years (25%), and >60 years (39%); p = 0.13. No patient had more than 3 abnormal EUS features. Hyperechoic stranding (n = 22) was the most common finding in all age groups. The odds for any abnormality in men (relative to women) was significantly higher (OR 2.9: 95% CI[1.2, 6.8], p = 0.01), with 38% of men and 18% of women having an abnormality. Smoking, low alcohol intake, body mass index, and endoscopic finding were not significantly associated with an abnormal EUS. The overall median pancreatic-gland width and main pancreatic duct diameter were 15 mm (IQR 6-25 mm) and 1.7 mm (IQR 0.9-4.3 mm), respectively.

Conclusions

The frequency of EUS abnormalities in patients without clinical evidence of chronic pancreatitis increases with age, particularly after 60 years of age. The threshold number of EUS criteria for the diagnosis of chronic pancreatitis is variable. However, the typically used standard of 3 or more criteria appears appropriate. A higher number of threshold criteria may be needed in males and to a lesser extent in patients over 40 years of age, which should be related to clinical history and other structural or functional studies. Ductal or parenchymal calculi, ductal narrowing, ductal dilatation, or more than 3 abnormalities appear to be more specific features for the EUS diagnosis of chronic pancreatitis at any age.

Section snippets

Study design

This was a prospective clinical study, with a target recruitment of 120 individuals. Patients were stratified according to age as follows: less than 40 years, 40 to 60 years, and more than 60 years. Patients scheduled to undergo EUS of the upper-GI tract for a nonpancreaticobiliary indication or routine upper endoscopy were considered for the study. Informed consent was obtained from all eligible patients before study enrollment. Each study patient underwent a detailed EUS examination of the

Results

Of 125 patients recruited for the study, 120 (median age 52 years, IQR 40-61 years) met enrollment criteria. Informed consent was obtained from all patients. Patient demographic data are tabulated in Table 2. Although 60 patients initially were enrolled into the 40 to 60 years age group, 4 patients in this group were reassigned to other age groups because of age discrepancies. Overall, 53% of patients recruited had no history of tobacco use. The majority of patients denied ingestion of alcohol

Discussion

EUS represents a major advance in GI imaging technology. EUS of the pancreas is particularly useful, because the gland can be visualized from the duodenum or the stomach. EUS has less risk than endoscopic retrograde pancreatography (ERP), traditionally the imaging test of choice and the criterion standard for chronic pancreatitis.3, 4, 5, 6, 7 In general, there is a good concordance between EUS and ERP in the diagnosis of moderate or severe pancreatitis but not for mild disease.2, 3, 8, 9, 10

To

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See CME section; p. 445.

Supported in part by the Miles and Shirley Fiterman Center for Digestive Diseases, Mayo Clinic and Foundation, Rochester, Minnesota.

Oral presentation at the annual Digestive Diseases Week, May 19-23, 2002, San Francisco, California (Gastrointest Endosc 2002;55:AB95).

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