896 Endoscopic Ultrasound on Diabetic Patients for Unexplained Abdominal Pain: High Prevalence of Parenchymal Abnormalities

Abstract

INTRODUCTION: The association between newly diagnosed Diabetes Mellitus (DM) and pancreatic ductal adenocarcinoma (PDAC) is a field of immense interest. Work up for unexplained abdominal pain (UAP) in DM patients could include endoscopic ultrasound (EUS). The aim of our study is to understand prevalence of pancreatic parenchymal and ductal changes during EUS in patients with DM being evaluated for UAP. METHODS: We retrospectively reviewed of charts of DM patients who underwent EUS at our center between 2010-2018 for the evaluation of UAP or other causes. Patients with known history of chronic pancreatitis (CP), pancreatic mass/PDAC or pancreatic surgery were excluded. RESULTS: A hundred and fourteen patients were identified (mean age = 66 ± 13.9 years; M:F = 48:66): 17 (14.9%) Blacks, 61 (53.5%) Whites, 66 (57.8%) Hispanics. Mean BMI was 31.3 ± 8.9. Eight patients (7%) had DM type 1 and 106 (93%) had type 2, with mean disease duration of 9.78 ± 6.4 years and mean HbA1c of 7.69 ± 1.8%. Eighty patients (70%) were on oral agents and 64 (55%) on insulin-based regimens. Diabetic complications were present in 60 patients (52.6%). Alcohol use was reported in 30 (26%) patients, and smoking in 44 (38.5%) patients (14.6 ± 26 mean pack/years). EUS was performed exclusively for UAP in 38 patients. Other indications included submucosal esophageal (2), gastric (13) or duodenal (3) lesion, CBD narrowing/dilation (21), abnormal hepatic panel (4), LAD on imaging (5), suspected choledocholithiasis (5), jaundice (2), and elevated CA-19-9 (3). Mean number of EUS procedures was 1.19 ± 0.5 and mean interval between procedures was 229.5 ± 203.6 days. Pancreatic abnormalities on non-EUS imaging were reported in 27 patients. On EUS, parenchymal or ductal abnormalities were present in 49 (42.9%) patients. Mean duration of disease in those noted to have EUS abnormalities was 10.6 ± 5.8 years. When defined using Rosemont classification, 2 met criteria for CP, 6 were indeterminate. In 106 patients classified as normal pancreas, lobularity was the commonest finding seen in 20 (18.8%) patients. Out of the 14 patients who underwent interval EUS, 3 patients showed progression of parenchymal and ductal changes. CONCLUSION: Endosonographic pancreatic abnormalities, not amounting to Rosemont definitions of CP, seem to be present in diabetic patients presenting with UAP. In our retrospective study, although 92.9% diabetic patients were classified to have normal pancreas, 38.6% of them had at least one abnormal finding on EUS.