Sarcopenia in Chronic Pancreatitis: An Overlooked Determinant of Outcomes in the Era of Endoscopic Management

Aims Chronic pancreatitis (CP) is a progressive inflammatory disease leading to irreversible pancreatic damage, resulting in exocrine and endocrine insufficiency. While endoscopic interventions effectively manage morphological complications of CP, they do not address the systemic impacts of malnutrition, frailty, and sarcopenia—factors increasingly recognized as critical contributors to morbidity and mortality in these patients. This systematic review and meta-analysis aimed to evaluate the prevalence of sarcopenia in CP patients and assess the modalities used for its diagnosis, highlighting the potential interplay between sarcopenia and outcomes in CP management, including endoscopic care [1] [2] [3] [4].

Methods A systematic search of Ovid MEDLINE and Embase databases (from inception to November 2024) was conducted in accordance with PRISMA guidelines. Studies reporting the prevalence of sarcopenia in CP patients, assessed through various diagnostic modalities (e.g., anthropometrics, bioelectrical impedance analysis, DEXA, CT, MRI, or ultrasound), were included. Random-effects proportional meta-analysis using the Freeman-Tukey double arcsine transformation was applied to pool prevalence estimates. Heterogeneity was assessed using the I² statistic, and subgroup analyses explored sources of variability.

Results Seventeen studies met the inclusion criteria were analyzed, with a total of 1,417 CP patients included. The pooled prevalence of sarcopenia was 52% [95% CI: 0.35; 0.69], with significant heterogeneity (I²=94%, p<0.01). The prediction interval [0.05–0.96] revealed variability in sarcopenia prevalence across populations and settings. These findings underscore the substantial burden of sarcopenia in CP, emphasizing its role as an underrecognized determinant of patient outcomes, including response to endoscopic therapy.

Conclusions Endoscopic therapies in CP focus primarily on resolving morphological complications, yet the high prevalence of sarcopenia highlights a gap in addressing the broader systemic impact of the disease. Sarcopenia and related malnutrition diminish pancreatic reserve and exacerbate frailty, contributing to poorer outcomes and increased mortality. Integrating nutritional and muscle-preserving strategies into CP care, alongside endoscopic management, could improve overall outcomes and patient survival. Future studies should focus on standardizing sarcopenia assessment and exploring its interplay with endoscopic outcomes to refine CP management strategies.

Publication History

Article published online:
27 March 2025

• References

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