Patterns of pancreatic fatty infiltration on endoscopic ultrasound: in-depth characterization

Background Diffuse echogenicity of the pancreas (DEP) is a hallmark of endoscopic ultrasound (EUS) diagnosis of fatty pancreas. This study aimed to characterize different patterns of DEP seen on EUS and its correlation with clinical and laboratory values. Methods This retrospective study includes patients diagnosed with fatty pancreas on EUS at a US tertiary center from January 2015 to June 2022. Fatty pancreas distribution was divided into three patterns: (a) The diffuse echogenicity of the entire pancreas with discrete hypoechoic areas ‘indicative of fatty sparing areas’, (b) diffuse echogenicity of the entire pancreas without any hypoechoic areas of fat sparing, and (c) diffuse echogenicity of the entire pancreas extending beyond the pancreatic border, ‘cotton candy appearance’. Results Overall, 238 patients were included (69.7% female). The average age of patients was 57.45 ± 12.93 years. The mean BMI was 31.27 ± 6.9 kg/m 2 . Concurrent diabetes and fatty liver were noted in 26.9 and 24.7% of the patients, respectively. The prevalence of exocrine pancreatic insufficiency (EPI) in those who underwent testing ( n = 68) was 33.8%. Type II was the most observed type in our cohort (44.1%). Type I and III were seen in 26.1 and 29.8% of the cohort, respectively. The three types of fatty pancreas had similar clinical patterns, with comparable prevalence of diabetes ( P = 0.9), fatty liver ( P = 0.9), and EPI ( P = 0.4). Conclusion The three patterns of DEP identified in this study have similar clinical and laboratory findings. Recognizing these patterns can aid in better detection of fatty pancreas.