A prospective pancreatographic study of the prevalence of pancreatic carcinoma in patients with diabetes mellitus

BACKGROUND The correlation between diabetes mellitus and pancreatic carcinoma is well documented, but no criteria have been established for the efficient selection of a high‐risk group among patients with diabetes mellitus. METHODS Eighty‐seven patients were selected prospectively from outpatients with diabetes and underwent endoscopic retrograde pancreatography (ERP) according to the authors' original criteria, including the onset of diabetes after age 55 years, deterioration of diabetes or loss of body weight despite strict medical control, elevation of serum amylase and/or CA19‐9 levels, and pancreatobiliary abnormalities on routine ultrasonography. The patients were divided into two groups according to the time from the onset of diabetes to ERP: Patients in Group A had recent‐onset diabetes (within 3 years), and Group B patients had diabetes for > 3 years. RESULTS A total of 86 patients (excluding 1 patient with unsuccessful ERP who had undergone previous Billroth‐2 gastrectomy) were enrolled. There were 33 males and 53 females, age 40–90 years, with a mean age of 65.1 years. ERP demonstrated pancreatic carcinoma, although it was advanced disease in all patients, at an extremely high rate of 7.0% (6 of 86 patients) with no serious complications. The prevalence of pancreatic carcinoma in Group A (13.9%; 5of 36 patients) was significantly greater compared with Group B (2.0%; 1 of 50 patients; P = 0.0442). ERP with an indwelling balloon catheter and subsequent pancreatic juice sampling was performed in 49 patients, yielding positive cytology in 1 patient with pancreatic tail carcinoma, whereas measurements of carcinoembryonic antigen and CA19‐9 levels in pancreatic juice were of no use in the diagnosis of pancreatic carcinoma. CONCLUSIONS Selective ERP in patients with diabetes who were at high risk did not lead to the early diagnosis of pancreatic carcinoma, although this study showed that the 3‐year period after the onset of diabetes was critical. A more aggressive diagnostic approach within this period in diabetic patients with the authors' criteria may contribute to the earlier diagnosis of pancreatic carcinoma. Cancer 2002;94:2344–9. © 2002 American Cancer Society. DOI 10.1002/cncr.10493 Endoscopic retrograde pancreatography revealed pancreatic carcinoma at an extremely high rate of 7.0% (6 of 86 patients) in patients with diabetes mellitus who were selected prospectively by the authors' original criteria. The prevalence of pancreatic carcinoma was s