13 Endoscopic Ultrasound for Screening Patients With Increased Risk of Pancreatic Ductal Adenocarcinoma: Miles to Go Before We Sleep

Abstract

INTRODUCTION: The incidence of pancreatic ductal adenocarcinoma (PDAC) is increasing worldwide, but early diagnosis of the disease is only possible in a minority of patients. In 2020, it is expected to be the second cause of mortality among all cancers. We aimed to access the value of endoscopic ultrasound (EUS) in screening a population with increased risk for PDAC. METHODS: We prospectively studied a cohort of 70patients considered to have increased risk of PDAC: chronic pancreatitis (CP), n = 30; hereditary risk (HR), n = 20; and new onset diabetes after age of 50 years (NOD), n = 20; Demographical and clinical data was collected. All patients were submitted to EUS with screening purpose, by 3 experienced endoscopists. RESULTS: We evaluated 70 patients with a median age of 54 years (49–61), 58.6% were male. In CP group [54 years (48–61), 76.7% male], 26.7% presented exocrine insufficiency, 30.0% endocrine insufficiency and 3.3% both. The etiology of CP was toxic (tobacco and/or alcohol) in 86.7%. In the HR group [49 years (41–56), 45.0% male], 65% presented Lynch Syndrome and 35% other hereditary syndromes with increased risk for PDAC. Fifteen percenthad already had the diagnosis of one or more digestive cancers. All of these individuals were asymptomatic for pancreatic diseases. In the NOD group [61 years (54–67), 45.0% male], all have the diagnosis in a time period inferior to 36 months, and all were under antidiabetic oral therapy. All subjects had normal CA 19.9 levels. In relation to EUS finding: in the CP group, 20.0% had mass forming disease, and all these patients were submitted to EUS-tissue acquisition that excluded malignancy. In HR group, all EUS findings were normal. In NOD group, EUS revealed a lipomatous pancreatic parenchyma in 4 (20.0%) patients, small simple cystic lesions in 2 (10.0%) and signs of incipient CP (indeterminate for CP according Rosemont criteria) in another 2 (10.0%). Overall, in the 3 groups, no suspicious solid lesion was found, nor a cystic one with worrisome features or high-risk stigmata. The median follow-up after EUS was 12 months (IQR 6–23). CONCLUSION: Regardless EUS is being considered one of the most accurate modalities for detection of pancreatic small/precursor lesions, our results (in accordance to the literature) do not support its use for routine screening of PDAC in the studied population.