S183 Pancreatic Head Fullness: A Retrospective Study of Diagnostic Pathways and Clinical Outcomes

Introduction: Pancreatic head fullness is an incidental imaging finding often seen on computed tomography (CT) or magnetic resonance imaging. The lack of standardized guidelines for evaluating this finding creates uncertainty in its management and outcomes. While limited studies, primarily focusing on CT scans, suggest that most cases are benign, the potential for malignancy underscores the need for a systematic approach. This study evaluates the diagnostic workup, outcomes, and management of patients with pancreatic head fullness at a single academic center. Methods: This retrospective study identified patients through radiology keyword searches for pancreatic head fullness on CT or magnetic resonance imaging from January 2020 to March 2024. Data collected included demographics, clinical history, endoscopic ultrasound with or without fine-needle aspiration or biopsy, tumor markers, final diagnoses, and treatments. Patients without definitive diagnoses or those lost to follow-up were excluded from the final analysis. Descriptive statistics summarized the findings. Results: Among 407 identified patients, 183 (45%) were excluded due to loss to follow-up or absence of further workup. The final analysis comprised 224 patients, with an average age of 59 years; 58% were men and 42% women. The racial distribution was 56% Black, 42% White, and 1% Hispanic. A history of pancreatitis was documented in 39% of patients. Ninety-four percent of patients reported tobacco or alcohol use. Endoscopic ultrasound was performed in 48% (n = 107), with 78 undergoing fine-needle aspiration/fine-needle biopsy. An elevated CEA level, either from the serum or cystic fluid, or an elevated CA 19-9 were seen in 62 patients. Diagnoses included both pancreatic and metastatic cancer (28%), pancreatitis (31%), pseudocysts (11%), and intraductal papillary mucinous neoplasms or serous/mucinous cystadenomas (6%). Treatments varied, with 42 patients (19%) undergoing surgery, 39 (17%) receiving chemotherapy, and 14 (6%) electing hospice. The remaining patients had benign findings that were managed with lifestyle modifications and surveillance. Conclusion: While many cases of pancreatic head fullness were benign, malignancy was identified in 28% of patients. The significant proportion of patients lost to follow-up or without further evaluation may have underestimated malignancy rates. These findings emphasize the importance of standardized diagnostic and management protocols to optimize patient outcomes and improve surveillance practices in patients with pancreatic head fullness detected on imaging.