Clinical outcomes and prevalence of cancer in patients with possible groove pancreatitis

Lekkerkerker, Selma J.; Nio, C. Yung; Issa, Yama; Fockens, Paul; Verheij, Joanne; Busch, Olivier R.; Gulik, Thomas M. van; Rauws, Erik A.; Boermeester, Marja A.; Hooft, Jeanin E. van; Besselink, Marc G.

doi:10.1111/jgh.13376

Cited by 15 publications

(20 citation statements)

References 19 publications

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“…One patient underwent EUS-guided transmural drainage for a symptomatic pancreatic pseudocyst prior to transpapillary pancreatic duct drainage. As the clinical presentations of groove pancreatitis and pancreatic cancer overlap, 7 during endoscopic treatment, exclusion of pancreatic malignancy was performed using EUS fine-needle aspiration in three cases, pancreatic duct brush cytology in one case, and direct biopsy in one case as shown in Table 1 . In the remaining case, follow-up imaging together with the chronicity of the symptoms made malignancy less likely.…”

Section: Resultsmentioning

confidence: 99%

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Groove Pancreatitis: Endoscopic Treatment via the Minor Papilla and Duct of Santorini Morphology

et al. 2018

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Background/AimsGroove pancreatitis (GP) is an uncommon disease involving the pancreaticoduodenal area. Possible pathogenesis includes obstructive pancreatitis in the duct of Santorini and impaired communication with the duct of Wirsung, minor papilla stenosis, and leakage causing inflammation. Limited data regarding endoscopic treatment have been published.MethodsSeven patients with GP receiving endoscopic treatment were reviewed. The morphology of the pancreatic duct was evaluated by a pancreatogram. Endoscopic dilation of the minor papilla and drainage of the duct of Santorini were performed.ResultsThere were two pancreatic divisum cases, one ansa pancreatica case and four impaired connections between the duct of Santorini and the main pancreatic duct. Three to 31 sessions of endoscopy, with 2 to 24 sessions of transpapillary stenting and dilation, were performed. Interventions through the minor papilla were successfully performed in six of seven cases. The pancreatic stenting duration ranged from 2 to 87 months. Five patients with evidence of chronic pancreatitis (CP) tended to receive more endoscopic interventions than did the two patients without CP (2–24 vs 2, respectively) for GP and other complications associated with CP.ConclusionsDisconnection or impairment of communication between the ducts of Santorini and Wirsung was observed in all cases of GP. No surgery was required, and endoscopic minor papilla dilation and drainage of the duct of Santorini were feasible for the treatment of GP.

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Section: Resultsmentioning

confidence: 99%

“…On the other hand, in those with CP, the process is rather fibrotic and has become irreversible. 7 Apart from the difference in background chronic pancreatitis, the number of endoscopic session seems to be less in those with shorter duration of symptom.…”

Section: Discussionmentioning

confidence: 99%

Groove Pancreatitis: Endoscopic Treatment via the Minor Papilla and Duct of Santorini Morphology

et al. 2018

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“…[ 19 ] Pancreatoduodenectomy still has considerable mortality (2%–3%) and morbidity rates (37%–40%). [ 20 ] Lekkerkerker et al [ 21 ] have reported 50% (4/8) adverse events in patients with GP after pancreaticoduodenectomy, where 13% (1/8) died postoperatively because of hypovolemic shock. A gastroenteroanastomosis may be a solution for patients with marked duodenal stenosis without intractable pain or in patients who are unfit for pancreatectomy.…”

Section: Discussionmentioning

confidence: 99%

Acute pancreatitis associated with duodenal obstruction induced by groove pancreatitis

Liu

et al. 2021

Medicine

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Rationale Groove pancreatitis (GP) is a rare form of chronic pancreatitis. Since GP presents with nonspecific symptoms, it can be challenging to diagnose. Duodenal obstruction is often caused by malignant diseases; however, when associated with acute pancreatitis, it is rarely induced by groove pancreatitis. Patient's concerns A 56-year-old man who presented with acute pancreatitis complained of recurrent upper abdominal discomfort. His concomitant symptoms included abdominal pain, postprandial nausea, and vomiting. Contrast-enhanced computed tomography (CT) of the abdomen showed thickening of the duodenum wall. Gastrointestinal radiographs and upper gastrointestinal endoscopy showed an obstruction of the descending duodenum. Diagnosis The pathologic diagnosis was groove pancreatitis. Interventions The patient underwent gastrojejunostomy to relieve the obstruction. Outcomes The patient had an uneventful recovery with no complications. Lessons Groove pancreatitis should be considered in the differential diagnosis of patients presenting with acute pancreatitis and duodenal obstruction. These data can help to make a precise diagnosis and develop an appropriate treatment plan.

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“…Most patients are admitted with abdominal pain, vomiting, weight loss, and abdominal imaging shows cystic lesions in the pancreatic head region. Differentiation from pancreatic cancer can be difficult in the absence of the cysts, and if it is not clear, surgery is indicated (9,10). Conservative and endoscopic treatment may be effective in almost 50% of patients, while surgery is still the best option (10).…”

Section: Introductionmentioning

confidence: 99%

“…Differentiation from pancreatic cancer can be difficult in the absence of the cysts, and if it is not clear, surgery is indicated (9,10). Conservative and endoscopic treatment may be effective in almost 50% of patients, while surgery is still the best option (10). A stepwise approach, starting with conservative treatment, followed by endoscopic and finally surgery seems a logical option.…”

Section: Introductionmentioning

confidence: 99%

Cystic Dystrophy of the Duodenal Wall in Heterotopic Pancreas with Groove Pancreatitis: A Diagnostic and Therapeutic Challenge

Barbu¹,

Valeanu²,

Muresan³

et al. 2018

chr

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A 48 years-old man, chronic alcohol consumer, with a history of recurrent mild acute pancreatitis episodes, was diagnosed in 2010 with segmental chronic pancreatitis complicated by a 4cm pseudocyst in the pancreatic head. He stopped drinking, but acute episodes continued to reoccur, while the pseudocyst disappeared. In 2012 the patient was admitted to our department with painful chronic pancreatitis and a new acute episode. EUS diagnosed a cystic dystrophy of the duodenal wall with groove pancreatitis, and endoscopic opening of the cysts into the duodenum was performed. Laparoscopic cholecystectomy was imposed by small gallbladder stones seen at EUS. After 6 months of silence, pain and acute episodes reappeared, imposing pancreatoduodenectomy. Patient is now well, without symptoms during 5 years of follow-up. Cystic dystrophy of heterotopic pancreas can be thought of in case of recurrent idiopathic acute pancreatitis. EUS is the best diagnosis tool, and can provide opening of the cysts into the duodenum. Surgery - pancreatoduodenectomy - offer best results.

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Clinical outcomes and prevalence of cancer in patients with possible groove pancreatitis

Abstract: Suspicion of pancreatic cancer should be high in patients presenting with possible GP. Conservative, endoscopic and surgical treatment can all lead to symptom improvement, suggesting a 'step-up approach' to GP once cancer is excluded.

Cited by 15 publications

References 19 publications

Groove Pancreatitis: Endoscopic Treatment via the Minor Papilla and Duct of Santorini Morphology

Groove Pancreatitis: Endoscopic Treatment via the Minor Papilla and Duct of Santorini Morphology

Acute pancreatitis associated with duodenal obstruction induced by groove pancreatitis

Cystic Dystrophy of the Duodenal Wall in Heterotopic Pancreas with Groove Pancreatitis: A Diagnostic and Therapeutic Challenge

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