Risk factors for hyperechogenic pancreas on endoscopic ultrasound: a case-control study

Hyperechogenic pancreas (HP) suggestive of fatty replacement is a common finding during endoscopic ultrasound (EUS). Recent data have implicated pancreatic steatosis as a risk factor for pancreatitis and pancreatic malignancy. Hepatic steatosis has been linked to obesity, increased age, hypertriglyceridemia, hyperglycemia, and hyperinsulinemia. The objective of this study was to evaluate the effect of body mass index (BMI), hepatic steatosis, and other metabolic risk factors on HP seen on EUS.

Patients with HP were identified by a review of a structured EUS database. The degree of echogenicity was judged relative to the liver (or spleen if the liver is hyperechogenic) at a similar depth. Various demographic and metabolic risk factors were assessed. Chronic pancreatitis was excluded based on normal findings on prior imaging studies. Each case was age matched and sex matched to 1 control with a normal pancreas on EUS.

By multivariate logistic regression analysis, BMI, hepatic steatosis, and alcohol use in excess of 14 g/wk were highly associated with the presence of HP compared with controls (all P<0.002). Hepatic steatosis was the strongest predictor with an odds ratio of nearly 14-fold.

Hepatic steatosis, alcohol use, and increased BMI are predictors of HP, which can be a marker for steatosis.