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

Abstract

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.

Pancreatoduodenectomy for groove pancreatitis: A case report and literature review

“…As regards the types of therapeutic strategies, patients diagnosed with groove pancreatitis can be initially subjected to medical therapies in order to provide an effective analgesic effect and to provide an adequate substitution of pancreatic function (10,11). In cases in which the symptoms are solely produced by pancreatic duct obstruction, endoscopic procedures in order to provide an effective drainage of the pancreatic secretion via endoscopy may be taken in consideration (12). However, this method may not be applicable in cases presenting with severe duodenal stenosis or in which the pre-operative investigations could not exclude the association of malignant transformation (3).…”

Diagnostic Dilemma in Groove Pancreatitis: A Case Report

“… 6 Endoscopic stenting of minor papilla also has been done but a long-term outcome is yet to be established. 6 , 7 Most patients who fail medical therapy are managed with Pancreaticoduodenectomy due to marked duodenal stenosis, endocrine and exocrine failure, progressive pain, and when malignancy cannot be ruled out. 8 Aguilera et al treated eight patients with pylorus-preserving pancreaticoduodenectomy by both open and laparoscopic approach with no major complications and they found the resolution of pancreatitis and improvements in symptoms in during median follow up 18.15 month.…”

Egy diagnosztikus kihívás: paraduodenalis pancreatitis. Két eset bemutatása

“…Amennyiben a gondos kivizsgálás után nagy valószínűséggel a paraduodenalis pancreatitis diagnózisa állítható fel, a betegség lefolyásának rendszeres kontrollja mellett lehetséges a konzervatív kezelés, mely magában foglalja a pancreas nyugalomba helyezését, a fájdalom csillapítását, szigorú alkoholmegvonás mellett, szükség esetén endoszkóposan elvégezhető beavatkozásokkal, mint a duodenum tágítása, pancreaticus vagy epeúti drenázs, cystenterostomia [8,9,13,[27][28][29]. A szomatosztatinanalóg kezelésnek a fájdalomra gyakorolt, noha csak rövid távon leírt kedvező hatását több szerző is említi.…”