International Multidisciplinary Consensus Report on Definitions, Diagnostic Criteria, and Management of Fatty Pancreas: A Joint Statement Endorsed by EPC, APA, EASD, EASL, ESGAR, ESGE, ESP, ESPCG, ESPEN, ESPGHAN, IAP, JPS, KPBA, LAPSG, and UEG
UEG · 2026 · Europe
Source and licence
- Authors
- Miroslav Vujasinovic, Ihsan Ekin Demir, Giovanni Marchegiani et al.
- Title
- International Multidisciplinary Consensus Report on Definitions, Diagnostic Criteria, and Management of Fatty Pancreas: A Joint Statement Endorsed by EPC, APA, EASD, EASL, ESGAR, ESGE, ESP, ESPCG, ESPEN, ESPGHAN, IAP, JPS, KPBA, LAPSG, and UEG
- Journal
- United European Gastroenterology Journal, 2026
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC12906299
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Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
Chapter 1
- Statement 1The most suitable and encompassing term to describe all forms of fat in the pancreas is “fatty pancreas,” and we recommend its adoption for general use.Level of evidence: N/A ‐ this is a consensus‐based terminology decision, not a clinical question evaluated through evidence.
Chapter 2
- Statement 2Various factors, including aging, obesity, inflammation from diverse causes, genetic disorders, and chronic obstruction, contribute to a fatty pancreas. Multiple intra‐ and extra‐pancreatic cell types seem to have the potential to serve as precursors of intrapancreatic adipocytes.Level of evidence: 4.
Chapter 3
- Statement 3Currently, there is no convincing evidence of an increased prevalence or a causal relationship between alcohol consumption and cigarette smoking in the etiopathogenesis of fatty pancreas.Level of evidence: 3.
Chapter 4
- Statement 4The epidemiology of fatty pancreas is poorly understood. Due to the lack of standardized definitions and diagnostic criteria, prevalence estimates vary widely across studies. However, fatty pancreas is more common with increasing age, body mass index, waist circumference, metabolic syndrome, and diabetes.Level of evidence: 2.
Chapter 5
- Statement 5.1The hallmark of fatty pancreas is the presence of adipocytes, intralobularly and/or extralobularly. Extensive adipocyte accumulation is usually associated with loss of acinar parenchyma.Level of evidence: 5.
- Statement 5.2The distribution of fatty pancreas‐related changes may be patchy.Level of evidence: 5.
- Statement 5.3The histology of fatty pancreas beyond the presence of adipocytes has been poorly studied.Level of evidence: N/A.
- Statement 5.4There is currently no universally accepted, validated objective method for the histological assessment of the severity of fatty pancreas.Level of evidence: N/A.
Chapter 6
- Statement 6.1Transabdominal ultrasonography could suggest the presence of fatty pancreas; however, its diagnostic reliability and utility for assessing severity remain limited due to operator dependency, technical variability, and inconsistent criteria.Level of evidence: 3.
- Statement 6.2CT could assist in the diagnosis of fatty pancreas, particularly in advanced cases, but its sensitivity is limited for detecting milder forms.Level of evidence: 5.
- Statement 6.3MRI, particularly the use of proton density fat fraction (PDFF) sequences, is the most reliable technique for accurate pancreatic fat quantification.Level of evidence: 3.
- Statement 6.4MRI could be used for further characterization of pancreatic fat in patients with uncertain findings and suspected focal fatty pancreas that is not located in a characteristic area of the pancreas on ultrasonography and CT.Level of evidence: 5.
- Statement 6.5Automated artificial intelligence (AI)‐based measurement of pancreatic fat via MRI may enable objective, reproducible quantification, benefiting time management and large‐scale research studies. However, there is currently a lack of sufficient evidence on this subject.Level of evidence: 4.
Chapter 7
- Statement 7.1EUS can be used to diagnose fatty pancreas primarily through qualitative echogenicity assessment, typically characterized by hyperechoic pancreatic parenchyma compared to the spleen or adjacent organs. Nonetheless, a correlation between hyperechogenicity and histological fat accumulation is not established, and tissue acquisition cannot be recommended.Level of evidence: 4.
- Statement 7.3EUS imaging analysis via AI and advanced imaging techniques, such as shear wave elastography (SWE), show promising potential for evaluating fatty pancreas. However, no validation on the application of these techniques has been performed.Level of evidence: 4.
Chapter 8
- Statement 8.1Fatty pancreas may be a risk factor for acute pancreatitis.Level of evidence: 3.
- Statement 8.2Fatty pancreas may be associated with increased severity of AP.Level of evidence: 4.
Chapter 9
- Statement 9.1The evidence regarding the association between fatty pancreas and pancreatic exocrine function is inconclusive and may be influenced by underlying pancreatic disease.Level of evidence: 4.
- Statement 9.2Despite the evidence being limited at present, genome‐wide association studies and cohort studies suggest that a fatty pancreas is associated with the risk of chronic pancreatitis.Level of evidence: 4.
Chapter 10
- Statement 10.1Low‐quality evidence indicates that the prevalence of fatty pancreas may be higher in patients with IPMN than in patients without IPMN.Level of evidence: 4.
- Statement 10.2While fatty pancreas may be associated with an increased risk of IPMN progression, there is insufficient evidence for a definite conclusion or establishment of a causal relationship.Level of evidence: 4.
Chapter 11
- Statement 11.1Fatty pancreas is associated with pancreatic cancer. While direct causality and the exact mechanisms remain under investigation, a growing body of evidence suggests that patients with fatty pancreas are at an increased risk of developing pancreatic cancer.Level of evidence: 3.
Chapter 12
- Statement 12.1A fatty pancreas increases the risk of surgical complications.Level of evidence: 3.
Chapter 13
- Statement 13.1The prevalence of fatty pancreas is increased in children with obesity, type 2 DM, metabolic dysfunction‐associated steatotic liver disease (MASLD), as well as in children with cystic fibrosis, Shwachman–Diamond syndrome, or Pearson syndrome.Level of evidence: 3.
- Statement 13.2Fatty pancreas in children is increasingly recognized as a potential marker for metabolic syndrome, with its presence correlating with higher levels of abdominal adiposity.Level of evidence: 3.
Chapter 14
- Statement 14.1Fatty pancreas is associated with the presence of MASLD.Level of evidence: 1.
- Statement 14.2Fatty pancreas is associated with metabolic syndrome and its components, such as hypertension, hyperlipidemia, DM, and central overweight/obesity. As a consequence, fatty pancreas is associated with cardiovascular disease linked with metabolic syndrome.Level of evidence: 2.
Chapter 15
- Statement 15.1Fatty pancreas impacts the endocrine pancreas and may contribute to impaired insulin secretion and increased diabetes risk.Level of evidence: 2.
Chapter 16
- Statement 16.1There is no specific recommendation to treat fatty pancreas. Treatment relies on the underlying etiology. In case of metabolic syndrome, targeted lifestyle changes, bariatric surgery, and glucose‐lowering medications are effective in reducing fat in the pancreas and total pancreatic volume.Level of evidence: 1.
- Statement 16.2There are currently no specific recommendations for the follow‐up of individuals with fatty pancreas. Monitoring is tailored to the underlying pancreatic diseases and associated metabolic risk factors.Level of evidence: 4.
Abstract
This international, multidisciplinary consensus report represents the first effort to systematically define and characterize fatty pancreas. A key outcome of this endeavor was the recommendation to adopt “fatty pancreas” as the standardized and inclusive term to describe all forms of fat accumulation in the pancreas. This terminological consensus provides a critical foundation for unified reporting and clinical communication. Another major contribution of the report is the consensus on diagnostic imaging findings, which was based on radiological and endoscopic modalities. The proposed criteria aim to enhance consistency in clinical assessment and support the development of standardized research protocols. In addition to establishing terminology and diagnostic frameworks, the report also synthesizes current knowledge across a wide range of relevant domains. These include the etiology and epidemiology of fatty pancreas, as well as its associations with alcohol consumption, smoking, acute and chronic pancreatitis, pancreatic exocrine insufficiency, type 2 diabetes mellitus, and surgical outcomes. The potential links between fatty pancreas and neoplastic conditions such as intraductal papillary mucinous neoplasms and pancreatic cancer are also addressed, alongside the current understanding of its metabolic implications (beta‐cell function and glucose homeostasis) and treatment strategies. Throughout the consensus process, a consistent theme emerged: the limited availability of high‐quality, prospective clinical data. Therefore, many of the recommendations in this report are based on expert consensus rather than strong empirical evidence. As such, the statements require rigorous prospective validation before they can be adopted into routine clinical practice. This underscores a critical need for further research, particularly studies aimed at clarifying causal relationships, validating diagnostic tools, and determining the clinical relevance of fatty pancreas across diverse patient populations. This report serves as both a summary of our current understanding and a roadmap for future investigations, aiming to close existing knowledge gaps and guide evidence‐based clinical practice in this emerging field.
Contents of the original publication
The section headings of the original.
- Introduction
- Methods
- Initiative and the Steering Committee
- Participating Societies
- Participants
- Statements, Grades of Evidence, and Outcome Reporting
- Delphi Process
- Conclusion
- Supporting information
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