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Prospective Evaluation of Subjects With Chronic Asymptomatic Pancreatic Hyperenzymemia

Amodio, Antonio MD1; Manfredi, Riccardo MD2; Katsotourchi, Anna Maria MD1; Gabbrielli, Armando MD1; Benini, Luigi MD1; Mucelli, Roberto Pozzi MD2; Vantini, Italo MD1; Frulloni, Luca MD, PhD1

American Journal of Gastroenterology: July 2012 - Volume 107 - Issue 7 - p 1089–1095
doi: 10.1038/ajg.2012.125
Pancreas and Biliary Tract
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OBJECTIVES: Chronic asymptomatic pancreatic hyperenzymemia (CAPH) has been described since 1996 as a benign disease. Recent studies described pathological findings at magnetic resonance cholangiopancreatography with secretin stimulation (s-MRCP) in more than half of the CAPH subjects. The aim of this study was to investigate the frequency and clinical relevance of s-MRCP findings in patients with CAPH.

METHODS: Subjects prospectively enrolled from January 2005 to December 2010 underwent s-MRCP and biochemical tests routinely performed.

RESULTS: Data relative to 160 subjects (94 males, 66 females, age 49.6±13.6 years) were analyzed. In all, 51 (32%) subjects had hyperamylasemia, 9 (6%) hyperlipasemia, and 100 (62%) an increase in both enzyme levels. The time between the first increased dosage of serum pancreatic enzymes and our observation was 3.3±3.9 years (range: 1–15). Familial pancreatic hyperenzymemia was observed in 26 out of 133 subjects (19.5%). Anatomic abnormalities of the pancreatic duct system at s-MRCP were found in 24 out of 160 subjects (15%). Pathological MRCP findings were present in 44 subjects (27.5%) before and in 80 subjects (50%) after secretin administration (P<0.0001). Five subjects (3.1%) underwent surgery, 3 for pancreatic endocrine tumor, 1 for pancreatic adenocarcinoma, and 1 for intraductal papillary-mucinous neoplasia (IPMN) involving the main pancreatic duct, and 18 patients (11.3%) needed a follow-up (17 for IPMN and 1 for endocrine tumor).

CONCLUSIONS: Alterations of the pancreatic duct system at s-MRCP in subjects with CAPH can be observed in 50% of the subjects and are clinically relevant in 14.4% of cases.

1 Verona Pancreas Centre, Department of Medicine, University of Verona, Verona, Italy

2 Department of Radiology, University of Verona, Verona, Italy

Correspondence: Luca Frulloni, MD, PhD, Cattedra di Gastroenterologia, Policlinico GB Rossi, P.le LA Scuro, 10 37134 Verona, Italy. E-mail: luca.frulloni@univr.it

Received 31 October 2011; accepted 6 March 2012

published online 15 May 2012

© The American College of Gastroenterology 2012. All Rights Reserved.
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