Risk Factors for Hyperechogenic Pancreas on Endoscopic Ultrasound (EUS). A Case Controlled Study

Background: Hyperechogenic pancreas suggestive of fatty replacement is a common finding during EUS. Its clinical significance in the setting of a normal pancreas is unclear.

Hypothesis: Hyperechogenic pancreas on EUS is directly correlated with BMI and hepatic steatosis.

Methods: All patients with hyperechogenic pancreas were identified by review of a structured EUS database collected since 1996 at our Institution (n=60). EUS examinations were performed utilizing either radial or linear-array echoendoscope. The degree of echogenicity was judged relative to the liver (or spleen if liver is hyperechogenic) at a similar depth. Risk factors were identified by review of the electronic medical record including. Chronic pancreatitis was excluded based on normal cross-sectional imaging studies (CT, MRI). Each case was age-matched and gender-matched to 1 control with a normal pancreas (by EUS) within 3 years. Data was analyzed using univariate analysis and multivariate logistic regression.

Results: Patients' characteristics in each group are summarized in Table 1. Multivariate logistic regression analysis showed that BMI, hepatic steatosis and alcohol use in excess of 14 grams/week were highly associated with the presence of hyperechogenic pancreas compared to controls (all p<0.002). Hepatic steatosis was the strongest predictor with an odds ratio of nearly 14 fold.

Conclusion: Hepatic steatosis, alcohol use and increased BMI are predictors of hyperechogenic pancreas, which can be a marker for steatosis.

Table 1

*Wilcoxon rank-sum test †Fisher's exact test §Of patients with intact gallbladder
	Hyperechogenic Pancreasn=60	Normal Controlsn=60	p Value
Median Age (Range)	65 (30–88)	66 (30–86)	0.7*
Gender: Male	60%	60%	1.0†
Median BMI (Range)	31.7 (21.3–50.1)	25.4 (19.8–34.2)	<0.001*
Fatty Liver	57%	5%	<0.001†
Diabetes Mellitus	10%	7%	0.5†
Hyperlipidemia	42%	25%	0.1†
Hypertension	61%	45%	0.1†
+ve Family history	13%	7%	0.4†
Smoking	53%	55%	1.0†
Alcohol	55%	18%	<0.001†
Estrogen Use	13%	13%	1.0†
Abnormal pancreatic enzymes	8%	10%	1.0†
Cholecystectomy	17%	30%	0.1†
Cholelithiasis	18%§	14%§	0.8†