Iperenzimemia Pancreatica in Pazienti Asintomatici: Alterazioni Morfo-Funzionali del Pancreas e Studio di Patologie Associate.Follow-up.

Background: Chronic asymptomatic pancreatic hyperenzymemia (CAPH) has been described since 1996 as a benign disease. Recent studies described pathological findings at Magnetic Resonance Cholangio-Pancreatography with secretin stimulation in more than a half of the CAPH subjects. No study of follow-up was conducted so far in these subjects. Aim: to investigate the frequency and clinical relevance of s-MRCP findings in patients with CAPH; reevaluate the subjects after years to assess any radiological changes in time and / or appearance of symptoms. Methods: Subjects prospectively enrolled from January 2005 to December 2010 underwent s-MRCP and biochemical tests routinely performed, and then a part of them re-evaluated in follow-up. Results: Data relative to 160 subjects (94 males, 66 females, age 49.6 ± 13.6 years) were analyzed. Fifty-one (32%) subjects had hyperamylasemia, 9 (6%) hyperlipasemia, 100 (62%) an increase in both enzyme levels. 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 (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). In the follow-up study we obtained clinical data of 107 subjects and a radiological evaluation by MRCP in 66 subjects. One subject experienced acute pancreatitis after 5 years from the first detection of hyperenzymemia. Only one subject out of 11 with IPMN had progression of the size of the cyst, 1 out of 10 with SOD showed worsening of Wirsung duct dilation, while we observed a progression of chronic pancreatitis in 11% of subjects after mean follow-up of 3 ± 2 years. 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. Only a small part of the “functional” alterations observed at S-MRCP (SOD, suspected chronic pancreatitis) evolves into a chronic form of the disease.