Daniel Lew, MD, Kelly Wang, MD, Simon Lo, MD, Stephen Pandol, MD, Srinivas Gaddam, MD; Cedars-Sinai Medical Center, Los Angeles, CA
Introduction: Acute pancreatitis (AP) is a risk factor for pancreatic ductal adenocarcinoma (PDAC). EUS has been shown to have higher sensitivity than CT/MRI for the diagnosis of small PDAC.
The objective was to evaluate the impact of EUS for the diagnosis of PDAC after index AP. Methods: A retrospective cohort study of adults with AP who later developed biopsy proven PDAC between 2013 to 2019 at a tertiary care center was performed. PDAC patients were searched by ICD-9/10 and later confirmed by review of histopathology. These patients were reviewed for history of AP (Atlanta criteria). Patients were divided into two groups based on the imaging modality that first detected a pancreatic mass: CT/MRI group (mass seen on imaging and later underwent EUS for PDAC confirmation) and EUS group (CT/MRI did not find a pancreatic mass but later were confirmed to have PDAC on subsequent EUS). Results: 729 patients were found to have PDAC with 62 patients (8.5%) having history of AP. Median age of diagnosis for the index episode of AP was 65 (IQR, 57-72) years, and time to PDAC diagnosis occurred a median of 55 (IQR, 19-390) days after AP (Table 1). Median tumor size was 29.5 mm (IQR, 23-37), 46 patients (74%) had tumor in the head of the pancreas, and 35 patients (56%) underwent surgical resection. Overall, 39 patients (63%) died during the 21-month follow up period: 14 (47%) in EUS group and 25 (78%) in CT/MRI group (p=0.01). Median survival was 503 days (IQR, 265-859). 30 patients (48%) met criteria for EUS group and 32 patients (52%) for CT/MRI group. Indications for EUS after negative CT/MRI were idiopathic AP in 24 patients (75%) and dilated pancreatic duct in 8 patients (25%). EUS group had lower stage PDAC (Stage IA: 17% vs. 0%, p=0.02) and higher rates of surgical resection (70% vs. 44%, p=0.04) (Table 2) compared to CT/MRI group. Median survival for EUS group was 596 days (IQR, 392-904) compared to 327 days (IQR, 184-747) for CT/MRI group (p=0.15). In a subgroup analysis of PDAC diagnosed within 2 months of AP (n=32; n=18 in EUS group, n=14 in CT/MRI group) , median survival in EUS group was 536 days (IQR, 324-804) compared to 265 days (IQR, 144-767) in CT/MRI group (p=0.64). Discussion: EUS is likely to identify and diagnose early tumors that may not be seen on cross-sectional imaging. Our retrospective data makes a compelling argument for large scale future studies to evaluate the role of EUS after AP in patients deemed to be at high risk for PDAC.
Patient characteristics for entire cohort at time of acute pancreatitis episode and stratified by patients in EUS group and CT/MRI group.
PDAC characteristics including tumor size, location, stage, and treatments for the entire cohort, EUS group, and CT/MRI group.
Disclosures: Daniel Lew indicated no relevant financial relationships. Kelly Wang indicated no relevant financial relationships. Simon Lo indicated no relevant financial relationships. Stephen Pandol indicated no relevant financial relationships. Srinivas Gaddam indicated no relevant financial relationships.