895 Comparison of Endosonographic Pancreatic Abnormalities Between Diabetics and High Risk Individuals for PDAC

Abstract

INTRODUCTION: Several predisposing factors for pancreatic ductal adenocarcinoma (PDAC) have been described. High risk individuals (HRIs) are defined by presence of significant family history (FH) or predisposing genetic mutations/syndromes. Studies have postulated that Diabetes Mellitus (DM) could also play a role in PDAC; however, this relationship is not yet fully elucidated. We aimed to identify the prevalence and distribution of pancreatic parenchymal and ductal changes during EUS of DM patients compared to HRIs. METHODS: We retrospectively reviewed EUS findings of patients with DM or with a significant FH of PDAC and/or a predisposing high-risk genetic mutation/syndrome (BRCA2, PALB2, CDKN2A, ATM, Lynch and Peutz-Jeghers Syndrome). Significant FH was defined as (1): 2 or more relatives with PDAC, including at least one first-degree relative (FDR); (2) 3 or more non-FDR with PDAC. RESULTS: 100 patients were included: 78 in diabetes and 22 in HRI group (12 = significant FH, 7 = high-risk genetic mutations, 3 = Lynch Syndrome). Patient demographics are presented in Table 1. The mean number of EUS procedures was 1.25 ± 0.62 and mean interval between procedures was 299.3 ± 299 days. Pancreatic abnormalities on EUS were found in 47% of patients (Table 2). In HRI group, cysts was the commonest finding (9), out of which 7 had significant FH for PDAC. Cysts were consistent with Intraductal Papillary Mucinous Neoplasm (IPMN) in 8 patients. Pancreatic mass was evidenced in 3 cases, out of which 1 was found to be malignant. In DM group, the most frequent finding was lobularity (20), followed by main pancreatic duct (PD) dilation (8). Cysts were present in 4, with 1 malignant outcome. Mass was present in 4, with 2 diagnosed as PDAC and one as neuroendocrine tumor. When defined using the Rosemont classification, 3 patients had findings consistent with chronic pancreatitis, 2 in the DM group and 1 in the HRIs group. In the HRIs group, 8 patients underwent interval EUS, and new/additional pancreatic abnormality was seen in 1 patient. Nine patients in the DM group underwent interval EUS and 1 patient showed progression of changes. CONCLUSION: There is a clear difference in the most prevalent endosonographic findings in DM and HRI patient groups. Whereas cysts appear to be more prevalent in HRI for PDAC, diabetics have higher prevalence of lobularity on EUS examination. When available, repeat EUS examination demonstrated stable findings in almost all cases.