A prospective study of pancreatic disease in patients with alcoholic cirrhosis: comparative diagnostic value of ERCP and EUS and long-term significance of isolated parenchymal abnormalities

Background: The prevalence of pancreatic disease in patients with alcohol-r elated liver cirrhosis is uncertain. We assessed the prevalence of pancreat ic abnormalities in patients with alcoholic cirrhosis, and we compared endo scopic ultrasonography (EUS) and endoscopic retrograde cholangiopancreatogr aphy (ERCP) for the detection of chronic pancreatitis and other pancreatic lesions. In addition, we assessed the long-term significance of isolated pa ncreatic parenchymal abnormalities detected at EUS. Methods: EUS and ERCP were performed in each patient. Subjects with minimal parenchymal changes at initial EUS underwent clinical follow-up and subseq uent EUS and/or ERCP to document the occurrence, absence, or progression of these changes. Results: Seventy-two patients with alcoholic cirrhosis were recruited. Chro nic pancreatitis was diagnosed in 14 patients (19%) by both methods indepen dently. Isolated parenchymal lesions were observed in 18 patients by EUS al one. After a mean follow-up of 22 months the EUS appearance was unchanged. Ten of the 18 patients underwent follow-up ERCP and this was normal in all cases. Conclusions: This study demonstrated that (1) 19% of patients with alcoholi c cirrhosis have chronic pancreatitis, (2) an additional 25% have isolated pancreatic parenchymal changes at EUS, and (3) these parenchymal abnormalit ies do not progress during follow-up.