Non-Alcoholic Fatty Pancreas Disease, Pancreatic Cancer, and Impact of Endoscopic Ultrasound Examination on Screening and Surveillance

Fat accumulation in the pancreas, defined as fatty pancreas, is usually an incidental finding during transabdominal ultrasound examination. Fatty pancreas without any significant alcohol consumption is defined as non-alcoholic fatty pancreas disease. Even though its clinical impact is still largely unknown, hypothetically the disease progression could lead to chronic pancreatitis and possibly pancreatic cancer development. Recently, metabolic problems such as diabetes, central obesity, fatty liver, and dyslipidaemia have been considered important risk factors related to non-alcoholic fatty pancreas disease and pancreatic cancer; however, the exact mechanism is not yet fully understood. Early detection and screening for pancreatic cancer in clinical practice is troublesome because of the non-specific symptoms, anatomical location, accuracy of biomarkers in clinical practice, and high risk of radiation and contrast agent exposure from imaging study. Endoscopic ultrasound is still considered the best method for pancreas evaluation and for the screening and diagnosis of pancreatic cancer. However, there is still much debate regarding its cost, availability, and the training experience of the operator.