Systematic review on groove pancreatitis: management of a rare disease

Abstract

Background Groove pancreatitis is a focal form of chronic pancreatitis affecting the area of the paraduodenal groove. The aim of this systematic review was to assess the clinical presentation, diagnosis and treatment of patients with groove pancreatitis. Methods Medical literature databases (Embase, Medline via PubMed and Cochrane Central Register of Controlled Trials) were systematically searched for data recorded between 1 January 1990 and 31 August 2022 regarding patient characteristics, diagnosis, surgical treatment and outcomes. The following inclusion criteria were applied: RCTs, observational studies (cohort and case–control studies) and case studies with >3 cases including patients with groove pancreatitis undergoing medical, endoscopic or surgical treatment with available clinical and diagnostic data. Fisher’s exact test for binary data and Mann–Whitney U test or Student t-test for continuous data were adopted for statistical analysis. Results Of 649 studies, 44 were included, involving reports on 1404 patients with a mean age of 49 years. In 41 of the 44 studies in which patient gender was described, 86 per cent (N = 1023) of patients were male. Information on the risk factors of alcohol and nicotine was available in 37 and 23 studies, respectively. Seventy-nine per cent (N = 886) of patients had a history of excessive alcohol consumption and 83 per cent (N = 595) were smokers. Information on clinical symptoms was available in 37 of the 44 included studies and 78.5 per cent (N = 870) presented with abdominal pain. Some 27 studies comprising 920 groove pancreatitis patients were treatment oriented. Seventy-four per cent (N = 682) of patients were treated conservatively, 26.4 per cent (N = 134) underwent endoscopic treatment and 54.7 per cent (N = 503) required surgery. There was complete relief of symptoms in 35.6 per cent (N = 243) after conservative treatment, 55.2 per cent (N = 74) after endoscopic treatment and 69.6 per cent (N = 350) after surgical treatment. The median follow-up time was 42 months (range, 1–161 months). Conclusion Groove pancreatitis shows on imaging a typical triad: cystic lesions in the pancreatic duct or duodenal wall, calcifications, and thickenings of the duodenal wall. Surgery appears to be the most effective treatment modality.

Pancreaticoduodenectomy with Anatomical Vascular Variant in Groove Pancreatitis – a Case Report

“…Described for the first time as a separate entity by Stolte et al, in 1982 [5], groove pancreatitis remains a condition rarely described in the literature. Between 1990 and 2022 only 1404 cases were presented [6]. It mainly affects males in their 5 th and 6 th decades of life, with a history of alcohol misuse and heavy smoking.…”

“…Pancreaticoduodenectomy, with or without pylorus preservation, represents the most used technique for the treatment of groove pancreatitis, presenting a major advantage over all other procedures, where malignant degeneration cannot be excluded. The results of pancreaticoduodenectomy are obviously better than those obtained by conservative or endoscopic treatment, with a high percentage of total remission [4,6,14,16]. Although it shows the best results, pancreaticoduodenectomy is a major surgical procedure, with mortality at 90 days reaching 5% [17] and a postoperative morbidity that reaches 45% [18].…”

“…Although this differentiation can be extremely difficult without an anatomopathologic examination, Ukegjini et al, in a review including 1404 patients, found some significant criteria that advocate a groove pancreatitis. The factors suggesting groove pancreatitis are: young age, male gender, a history of alcohol misuse and heavy smoking, presentation with pain without jaundice and inflammatory and/or cystic changes in the duodenal wall [6]. Moreover, one third of the patients with groove pancreatitis showed elevated levels of carcioembrionar antigen and CA 19-9 [19], making the precise diagnosis more difficult since there is no threshold for this lab tests that could allow the differentiation between the two conditions.…”

Rendezvous-assisted endoscopic retrograde pancreatography in groove pancreatitis with a nondilated pancreatic duct

“…Groove pancreatitis is a rare form of chronic pancreatitis that affects the paraduodenal area 1 . Currently, its treatment strategy remains controversial, and endoscopic treatment is often indicated for patients with chronic pain not responding to conservative treatment 2 . When conventional ERP fails, RV-ERP could be an effective alternative method 3 .…”

The Hidden Agony of the Pancreas: A Comprehensive Case Study of Paraduodenal Pancreatitis

“…The diagnosis of PP heavily relies on advanced imaging techniques, particularly computed tomography (CT) and magnetic resonance imaging (MRI), which are crucial for identifying the characteristic findings associated with this condition [1,5]. Management of PP follows a "step-up" approach, starting with conservative treatment, including pain relief and alcohol cessation, and progressing to endoscopic and surgical interventions as necessary [6].…”