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Fan X, Shi C, Lu D. Groove pancreatitis presenting with upper gastrointestinal obstruction and abnormal renal function: A case report and literature review. Exp Ther Med 2024; 28:296. [PMID: 38827474 PMCID: PMC11140290 DOI: 10.3892/etm.2024.12585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 05/01/2024] [Indexed: 06/04/2024] Open
Abstract
Groove pancreatitis (GP) is a rare type of chronic pancreatitis characterized by fibrotic lesions localized to the groove between the pancreatic head, duodenum, and common bile duct. We present a case of a 59-year-old male alcoholic with vomiting and renal dysfunction found to have duodenal obstruction and low-density pancreatic head lesions on computed tomography concerning for GP. The patient underwent pancreaticoduodenectomy and pathology confirmed the diagnosis postoperatively. The patient recovered well without complications or relapse at follow-up. Although rare, GP should be included in the differential for pancreatic head masses in middle-aged alcoholics and surgical resection may be necessary for symptom relief and exclusion of malignancy.
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Affiliation(s)
- Xiaoyuan Fan
- Department of Gastroenterology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang 315000, P.R. China
| | - Chihong Shi
- Department of Gastroenterology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang 315000, P.R. China
| | - Dewen Lu
- Department of Gastroenterology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang 315000, P.R. China
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She YM, Ge N. Diagnostic value of endoscopic ultrasound in groove pancreatitis. Ann Med 2023; 55:2295991. [PMID: 38134890 PMCID: PMC10763902 DOI: 10.1080/07853890.2023.2295991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Aim: Groove pancreatitis (GP) is a rare type of chronic pancreatitis characterized by varying degrees of thickening and scarring of the duodenal wall, duodenal lumen stenosis, mucosal hypertrophy with plicae and cyst formation. GP is primarily observed in middle-aged male patients with a history of alcohol consumption. Clinical symptoms are usually non-specific, and there is currently no unified diagnostic standard. However, imaging methods, particularly endoscopic ultrasound (EUS), are useful for diagnosis. EUS-guided biopsy can provide a strong basis for the final diagnosis. This review summarizes the value of EUS and its derivative technologies in the diagnosis, differential diagnosis and treatment of GP.Methods: After searching in PubMed and Web of Science databases using 'groove pancreatitis (GP)' and 'endoscopic ultrasonography (EUS)' as keywords, studies related were compiled and examined.Results: EUS and its derivative technologies are of great significance in the diagnosis, differential diagnosis, and treatment of GP, but there are still limitations that need to be comprehensively applied with other diagnostic methods to obtain the most accurate results.Conclusion: EUS has unique value in both the diagnosis and treatment of GP. Clinicians need to be well-versed in the advantages and limitations of EUS for GP diagnosis to select the most suitable imaging diagnostic method for different cases and to reduce the unnecessary waste of medical resources.
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Affiliation(s)
- Yu Mo She
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Nan Ge
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
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3
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Ukegjini K, Steffen T, Tarantino I, Jonas JP, Rössler F, Petrowsky H, Gubler C, Müller PC, Oberkofler CE. Systematic review on groove pancreatitis: management of a rare disease. BJS Open 2023; 7:zrad094. [PMID: 37749756 PMCID: PMC10519812 DOI: 10.1093/bjsopen/zrad094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/12/2023] [Accepted: 08/08/2023] [Indexed: 09/27/2023] Open
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.
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Affiliation(s)
- Kristjan Ukegjini
- Department of Surgery and Transplantation, Swiss HPB & Transplant Center Zurich, University Hospital Zurich, Zürich, Switzerland
- Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Thomas Steffen
- Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Ignazio Tarantino
- Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Jan P Jonas
- Department of Surgery and Transplantation, Swiss HPB & Transplant Center Zurich, University Hospital Zurich, Zürich, Switzerland
| | - Fabian Rössler
- Department of Surgery and Transplantation, Swiss HPB & Transplant Center Zurich, University Hospital Zurich, Zürich, Switzerland
| | - Henrik Petrowsky
- Department of Surgery and Transplantation, Swiss HPB & Transplant Center Zurich, University Hospital Zurich, Zürich, Switzerland
| | - Christoph Gubler
- Department of Gastroenterology and Hepatology, Stadtspital Zürich, Zurich, Switzerland
| | - Philip C Müller
- Department of Surgery and Transplantation, Swiss HPB & Transplant Center Zurich, University Hospital Zurich, Zürich, Switzerland
- Department of Surgery, Clarunis—University Centre for Gastrointestinal and Hepatopancreatobiliary Diseases, Basel, Switzerland
| | - Christian E Oberkofler
- Department of Surgery and Transplantation, Swiss HPB & Transplant Center Zurich, University Hospital Zurich, Zürich, Switzerland
- Vivévis AG—Visceral, Tumor and Robotic Surgery, Clinic Hirslanden Zurich, Zurich, Switzerland
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Usenko O, Khomiak I, Khomiak A, Malik A, Kropelnytskyi V, Krol M. Duodenum-preserving pancreatic head resection or pancreatoduodenectomy for the surgical treatment of paraduodenal pancreatitis: a retrospective cohort study. Langenbecks Arch Surg 2023; 408:178. [PMID: 37140631 DOI: 10.1007/s00423-023-02917-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 04/28/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE Paraduodenal pancreatitis (PDP) is an uncommon yet well-described type of focal chronic pancreatitis. The aim of our study was to compare the outcomes of surgical treatment of patients with PDP using pancreatoduodenectomy and duodenum-preserving pancreatic head resection (DPPHR). METHODS A retrospective analysis of 153 consecutive patients with PDP was performed. Patients who were treated with either DPPHR or PD were enrolled. The primary endpoint of the study was pain control achieved at the time of follow-up. The secondary endpoints of the study were complication rate (Clavien-Dindo > 2), hospital length of stay, and 90-day mortality. All patients were followed up after discharge for the assessment of pain cessation for a minimal period of 10 months. RESULTS The final study population consisted of 71 patients. A total of 14 patients (19.7%) underwent pancreatoduodenectomy, and 57 (80.3%) were managed with DPPHR. Complication rate was significantly lower in DPPHR group at χ2 = 4.2677, p < 0.05. Mean hospital length of stay was 9.3 days (range 3-29) in DPPHR group and 13.9 days (range 7-35) in PD group (p < 0.05). No postoperative mortality was recorded. The mean follow-up period of the patients after surgery was 41.8 ± 20.6 months (range 10-88). Pain scores at the time of operation were calculated as 50.9 ± 12.1 in DPPHR group and 56.1 ± 11.4 in PD group. At the time of follow-up, pain scores improved significantly in both groups and were 10.3 ± 8.8 and 10.9 ± 8.6, respectively. CONCLUSION DPPHR achieves similar results in pain control as PD with a lower complication rate and shorter hospital LOS.
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Affiliation(s)
- Oleksandr Usenko
- Department of Pancreatic and Bile Duct Surgery, Shalimov National Institute of Surgery and Transplantology, Kyiv, Ukraine
| | - Igor Khomiak
- Department of Pancreatic and Bile Duct Surgery, Shalimov National Institute of Surgery and Transplantology, Kyiv, Ukraine
| | - Andrii Khomiak
- Department of Surgery, University of Colorado Anschutz Medical Campus, 12631 E 17th Ave, Aurora, CO, 80045, USA.
| | - Andrii Malik
- Department of Pancreatic and Bile Duct Surgery, Shalimov National Institute of Surgery and Transplantology, Kyiv, Ukraine
| | - Vladislav Kropelnytskyi
- Department of Pancreatic and Bile Duct Surgery, Shalimov National Institute of Surgery and Transplantology, Kyiv, Ukraine
| | - Mark Krol
- Department of Pancreatic and Bile Duct Surgery, Shalimov National Institute of Surgery and Transplantology, Kyiv, Ukraine
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Teo J, Suthananthan A, Pereira R, Bettington M, Slater K. Could it be groove pancreatitis? A frequently misdiagnosed condition with a surgical solution. ANZ J Surg 2022; 92:2167-2173. [PMID: 35916436 PMCID: PMC9543432 DOI: 10.1111/ans.17939] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/14/2022] [Accepted: 07/14/2022] [Indexed: 11/28/2022]
Abstract
Background Groove pancreatitis (GP) is an underrecognised subtype of chronic pancreatitis, focally affecting the area between the duodenum and pancreatic head. It most commonly affects males between 40 and 50 years of age with a history of alcohol misuse. Patients most commonly complain of abdominal pain and vomiting. Due to its focal nature, it is a potentially surgically treatable form of chronic pancreatitis. We report results of patients surgically treated for groove pancreatitis followed by a literature review of patient outcomes post resection. Methods A retrospective chart review of patients with histopathologically confirmed GP post‐surgical resection at the Princess Alexandra Hospital and Greenslopes Private Hospital in Brisbane, Australia was conducted between 2013 and 2020. Diagnosis was confirmed histologically when Brunner gland hyperplasia and chronic inflammation/fibrosis were found within the pancreaticoduodenal interface. Preoperative and postoperative symptoms were analysed along with complications. Additionally, a systematic review on outcomes of patients undergoing pancreaticoduodenectomy (PD) for GP was performed from three databases. Results Eight patients underwent surgery for GP. Elimination of preoperative symptoms was achieved in five of the eight patients. Major complications included one take back to theatre for pancreatic leak. Our literature review found complete resolution of pain and vomiting in 80% of GP patients after PD. Conclusion Optimal management of GP begins with early recognition. Symptoms from GP are likely to respond well to surgical intervention. We advocate for aggressive surgical resection in a patient with a high index of suspicion for GP.
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Affiliation(s)
- Joshua Teo
- Hepatopancreatobiliary Surgery Unit, Level 4, The Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Arul Suthananthan
- Hepatopancreatobiliary Surgery Unit, Level 4, The Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Ryan Pereira
- Hepatopancreatobiliary Surgery Unit, Level 4, The Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | | | - Kellee Slater
- Hepatopancreatobiliary Surgery Unit, Level 4, The Princess Alexandra Hospital, Brisbane, Queensland, Australia.,General Surgery, Greenslopes Private Hospital, Brisbane, Queensland, Australia
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Avery N, McNeilage AG, Stanaway F, Ashton-James CE, Blyth FM, Martin R, Gholamrezaei A, Glare P. Efficacy of interventions to reduce long term opioid treatment for chronic non-cancer pain: systematic review and meta-analysis. BMJ 2022; 377:e066375. [PMID: 35379650 PMCID: PMC8977989 DOI: 10.1136/bmj-2021-066375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To review interventions to reduce long term opioid treatment in people with chronic non-cancer pain, considering efficacy on dose reduction and discontinuation, pain, function, quality of life, withdrawal symptoms, substance use, and adverse events. DESIGN Systematic review and meta-analysis of randomised controlled trials and non-randomised studies of interventions. DATA SOURCES Medline, Embase, PsycINFO, CINAHL, and the Cochrane Library searched from inception to July 2021. Reference lists and previous reviews were also searched and experts were contacted. ELIGIBILITY CRITERIA FOR STUDY SELECTION Original research in English. Case reports and cross sectional studies were excluded. DATA EXTRACTION AND SYNTHESIS Two authors independently selected studies, extracted data, and used the Cochrane risk-of-bias tools for randomised and non-randomised studies (RoB 2 and ROBINS-I). Authors grouped interventions into five categories (pain self-management, complementary and alternative medicine, pharmacological and biomedical devices and interventions, opioid replacement treatment, and deprescription methods), estimated pooled effects using random effects meta-analytical models, and appraised the certainty of evidence using GRADE (grading of recommendations, assessment, development, and evaluation). RESULTS Of 166 studies meeting inclusion criteria, 130 (78%) were considered at critical risk of bias and were excluded from the evidence synthesis. Of the 36 included studies, few had comparable treatment arms and sample sizes were generally small. Consequently, the certainty of the evidence was low or very low for more than 90% (41/44) of GRADE outcomes, including for all non-opioid patient outcomes. Despite these limitations, evidence of moderate certainty indicated that interventions to support prescribers' adherence to guidelines increased the likelihood of patients discontinuing opioid treatment (adjusted odds ratio 1.5, 95% confidence interval 1.0 to 2.1), and that these prescriber interventions as well as pain self-management programmes reduced opioid dose more than controls (intervention v control, mean difference -6.8 mg (standard error 1.6) daily oral morphine equivalent, P<0.001; pain programme v control, -14.31 mg daily oral morphine equivalent, 95% confidence interval -21.57 to -7.05). CONCLUSIONS Evidence on the reduction of long term opioid treatment for chronic pain continues to be constrained by poor study methodology. Of particular concern is the lack of evidence relating to possible harms. Agreed standards for designing and reporting studies on the reduction of opioid treatment are urgently needed. REVIEW REGISTRATION PROSPERO CRD42020140943.
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Affiliation(s)
- Nicholas Avery
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Pain Management Research Institute, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Amy G McNeilage
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Pain Management Research Institute, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Fiona Stanaway
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Claire E Ashton-James
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Pain Management Research Institute, Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Fiona M Blyth
- Pain Management Research Institute, Kolling Institute, University of Sydney, Sydney, NSW, Australia
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Rebecca Martin
- Michael J Cousins Pain Management and Research Centre, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Ali Gholamrezaei
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Wang YL, Tong CH, Yu JH, Chen ZL, Fu H, Yang JH, Zhu X, Lu BC. Complete duodenal obstruction induced by groove pancreatitis: A case report. World J Clin Cases 2019; 7:4106-4110. [PMID: 31832415 PMCID: PMC6906566 DOI: 10.12998/wjcc.v7.i23.4106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/08/2019] [Accepted: 11/15/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Groove pancreatitis (GP) is a type of chronic pancreatitis occurring in an anatomic area between the duodenum, head of the pancreas, and common bile duct. Duodenal obstruction is always caused by malignant pancreatic diseases, such as pancreatic head carcinoma, while is rarely induced by benign pancreatic diseases, such as pancreatitis.
CASE SUMMARY A 39-year-old man presented with a 1-mo history of upper abdominal discomfort. His concomitant symptoms were abdominal distension, postprandial nausea, and vomiting. Contrast-enhanced computed tomography of the abdomen showed thickening of the intestinal wall with enhancement of the descending segment of the duodenum, which could not be clearly differentiated from the head of the pancreas. Upper gastrointestinal radiographs and gastrointestinal endoscopy showed a complete obstruction of the descending duodenum. An operation found that a 3-cm mass was located in the “groove part” of the pancreas and oppressing the descending duodenum. Pancreaticoduodenectomy was performed to relieve the obstruction and thoroughly remove the pancreatic lesions. The pathologic diagnosis was pancreatitis. The patient had an uneventful recovery with no complications.
CONCLUSION Because of the special location and the contracture induced by long-term chronic inflammation, our case reminds surgeons that some benign pancreatic diseases, such as GP, can also present with symptoms similar to those of pancreatic cancer. This knowledge can help to avoid an unnecessary radical operation.
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Affiliation(s)
- Ya-Li Wang
- Department of Hepatobiliary Surgery, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing 312000, Zhejiang Province, China
| | - Chen-Hao Tong
- Department of Hepatobiliary Surgery, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing 312000, Zhejiang Province, China
| | - Jian-Hua Yu
- Department of Hepatobiliary Surgery, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing 312000, Zhejiang Province, China
| | - Zhi-Liang Chen
- Department of Hepatobiliary Surgery, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing 312000, Zhejiang Province, China
| | - Hong Fu
- Department of Hepatobiliary Surgery, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing 312000, Zhejiang Province, China
| | - Jian-Hui Yang
- Department of Hepatobiliary Surgery, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing 312000, Zhejiang Province, China
| | - Xin Zhu
- Department of Hepatobiliary Surgery, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing 312000, Zhejiang Province, China
| | - Bao-Chun Lu
- Department of Hepatobiliary Surgery, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing 312000, Zhejiang Province, China
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Lekkerkerker SJ, Nio CY, Issa Y, Fockens P, Verheij J, Busch OR, van Gulik TM, Rauws EA, Boermeester MA, van Hooft JE, Besselink MG. Clinical outcomes and prevalence of cancer in patients with possible groove pancreatitis. J Gastroenterol Hepatol 2016; 31:1895-1900. [PMID: 26997497 DOI: 10.1111/jgh.13376] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/07/2016] [Accepted: 03/15/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIM Data on non-surgical treatment of groove pancreatitis (GP) and the risk of cancer are lacking. We aimed to determine the prevalence and predictors of cancer in patients in whom the diagnosis GP was considered, and to evaluate symptom improvement after treatment. STUDY Patients referred with possible GP (2001-2014) were retrospectively included. An experienced radiologist reassessed imaging. GP patients received questionnaires evaluating their symptoms. RESULTS From the 38 possible GP patients, 10 had cancer (26%) and 28 GP (74%). Compared with cancer patients, GP patients more frequently had cysts (2/10 vs. 18/28, P = 0.03), less often jaundice (6/10 vs 3/27, P < 0.01), an abrupt caliber change of the CBD (5/10 vs. 2/28, P < 0.01) or suspicious cytology (5/9 vs 2/20, P = 0.02). Of the 28 GP patients, 14 patients were treated conservatively of whom 12 reported symptom improvement after a median follow-up of 45 months (range 7-127 months). All 6 patients treated endoscopically and 7/8 patients treated surgically reported symptom improvement. Surgery, performed because of treatment failure (3/8) or inability to exclude malignancy (5/8), caused mortality in 1/8 patients. CONCLUSIONS 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.
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Affiliation(s)
- Selma J Lekkerkerker
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Chung Y Nio
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Yama Issa
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Joanne Verheij
- Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Olivier R Busch
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Thomas M van Gulik
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Erik A Rauws
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Marja A Boermeester
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Marc G Besselink
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Kit OI, Gevorkyan YA, Maksimov AY, Maslov AA, Snezhko AV, Kolesnikov EN, Kozhushko MA, Myagkov RE. [The outcomes of different pancreatodigestive anastomoses in pancreatoduodenectomy]. Khirurgiia (Mosk) 2016:43-46. [PMID: 27296121 DOI: 10.17116/hirurgia2016643-46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To compare early results after pancreaticoduodenectomy depending on variant of pancreatico-digestive anastomosis. MATERIAL AND METHODS It was analyzed early results of 207 pancreaticoduodenectomies for cancer which were performed for the period 2010-2014. Pancreatointestinal and pancreatogastric anastomoses were applied in 165 and 42 patients respectively. RESULTS Complications were observed in 73 (44.2%) and 18 (38.3%) patients after pancreatointestinal and pancreatogastric anastomoses respectively. Six patients died after pancreatointestinal anastomosis. At the same time there were no deaths in the group of pancreatogastric anastomosis. Differences were significant. Postoperative hospital-stay was similar in both groups.
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Affiliation(s)
- O I Kit
- Rostov Research Cancer Institute of Health Ministry of the Russian Federation, Russia
| | - Yu A Gevorkyan
- Rostov Research Cancer Institute of Health Ministry of the Russian Federation, Russia
| | - A Yu Maksimov
- Rostov Research Cancer Institute of Health Ministry of the Russian Federation, Russia
| | - A A Maslov
- Rostov Research Cancer Institute of Health Ministry of the Russian Federation, Russia
| | - A V Snezhko
- Rostov Research Cancer Institute of Health Ministry of the Russian Federation, Russia
| | - E N Kolesnikov
- Rostov Research Cancer Institute of Health Ministry of the Russian Federation, Russia
| | - M A Kozhushko
- Rostov Research Cancer Institute of Health Ministry of the Russian Federation, Russia
| | - R E Myagkov
- Rostov Research Cancer Institute of Health Ministry of the Russian Federation, Russia
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Gravito-Soares M, Gravito-Soares E, Alves A, Gomes D, Almeida N, Tralhão G, Sofia C. Groove Pancreatitis with Biliary and Duodenal Stricture: An Unusual Cause of Obstructive Jaundice. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2016; 23:170-174. [PMID: 28868454 PMCID: PMC5580193 DOI: 10.1016/j.jpge.2015.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 09/06/2015] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Groove pancreatitis is an uncommon cause of chronic pancreatitis that affects the groove anatomical area between the head of the pancreas, duodenum, and common bile duct. CLINICAL CASE A 67-year-old man with frequent biliary colic and an alcohol consumption of 30-40 g/day was admitted to the hospital complaining of jaundice and pruritus. Laboratory analysis revealed cholestasis and the ultrasound scan showed intra-hepatic biliary ducts dilatation, middle third cystic dilatation of common bile duct, enlarged Wirsung and pancreatic atrophy. The magnetic resonance cholangiopancreatography showed imaging findings compatible with groove pancreatitis. An esophagogastroduodenoscopy later excluded duodenal neoplasia. He was submitted to a Roux-en-Y cholangiojejunostomy because of common bile duct stricture. Five months later a gastrojejunostomy was performed due to a duodenal stricture. The patient remains asymptomatic during follow-up. DISCUSSION Groove pancreatitis is a benign cause of obstructive jaundice, whose main differential diagnosis is duodenal or pancreatic neoplasia. When this condition causes duodenal or biliary stricture, surgical treatment can be necessary.
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Affiliation(s)
- Marta Gravito-Soares
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Elisa Gravito-Soares
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Ana Alves
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Dário Gomes
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Nuno Almeida
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Guilherme Tralhão
- Surgery Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Carlos Sofia
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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11
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Groove Pancreatitis, a Masquerading Yet Distinct Clinicopathological Entity: Analysis of Risk Factors and Differentiation. Pancreas 2015; 44:901-8. [PMID: 25899649 DOI: 10.1097/mpa.0000000000000351] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Our objective was to delineate predictive factors differentiating groove pancreatitis (GP) from other lesions involving the head of the pancreas (HOP). METHODS A case-control study of patients older than 10 years was performed comparing patients with GP to those with other surgically resected HOP lesions. RESULTS Thirteen patients with GP (mean ± SD age, 51.9 ± 10.5 years; 11 males [84.6%]), all with a history of smoking (mean, 37.54 ± 17.8 pack-years), were identified. Twelve patients (92.3%) had a history of heavy alcohol drinking (heavy alcohol [EtOH]). The mean lesion size was 2.6 ± 1.1 cm, and the CA 19-9 was elevated (>37 IU/mL) in 5 patients (45.5%). The most common histopathologic condition was duodenal wall cyst with myofibroblastic proliferation and changes of chronic pancreatitis in the HOP.Univariate analysis revealed decreasing age, male sex, weight loss, nausea/vomiting, heavy EtOH, smoking, and a history of chronic pancreatitis were predictive of GP. A multivariate analysis among smokers demonstrated that weight loss (P = 0.006; odds ratio, 11.96; 95% confidence interval, 2.1-70.2), and heavy EtOH (P < 0.001; odds ratio, 82.2; 95% confidence interval, 9.16-738.1) were most predictive of GP. Compared to pancreatic adenocarcinoma (n = 183), weight loss and heavy EtOH remained predictive of GP. CONCLUSION Groove pancreatitis in the HOP is associated with a history of heavy EtOH and weight loss. In the absence of these symptoms, it is essential to rule out a malignant lesion.
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Hungerford JP, Neill Magarik MA, Hardie AD. The breadth of imaging findings of groove pancreatitis. Clin Imaging 2015; 39:363-6. [DOI: 10.1016/j.clinimag.2015.01.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 12/22/2014] [Accepted: 01/30/2015] [Indexed: 01/13/2023]
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DeSouza K, Nodit L. Groove Pancreatitis: A Brief Review of a Diagnostic Challenge. Arch Pathol Lab Med 2015; 139:417-21. [DOI: 10.5858/arpa.2013-0597-rs] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Groove pancreatitis is an uncommon, yet well-described, type of focal chronic pancreatitis, affecting “the groove”—the area between the head of the pancreas, the duodenum, and the common bile duct. Men aged 40 to 50 years are most commonly affected, with a history of alcohol abuse frequently disclosed. Clinical manifestations are similar to other forms of chronic pancreatitis, and vomiting secondary to duodenal stenosis is the main feature. It is postulated that pancreatitis in the groove area arises from obstruction of pancreatic juices in the ductal system, causing fibrosis and stasis with resultant inflammation of surrounding structures. The minor papilla is frequently the anatomic area of preferential involvement. Groove pancreatitis poses diagnostic challenges, forming a “pseudotumor” that mimics pancreatic carcinoma. The distinction is important, although often impossible to make because of their similar presentation, with groove pancreatitis usually affecting younger patients. Most patients are successfully treated with pancreaticoduodenectomy when definitive pathologic diagnoses can be made.
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Affiliation(s)
- Karyn DeSouza
- From the Pathology Department, University of Tennessee Medical Center, Knoxville
| | - Laurentia Nodit
- From the Pathology Department, University of Tennessee Medical Center, Knoxville
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Ma S, Li Q, Dai W, Pan F. Pancreaticogastrostomy versus pancreaticojejunostomy. J Surg Res 2014; 192:68-75. [PMID: 24942400 DOI: 10.1016/j.jss.2014.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 03/20/2014] [Accepted: 05/02/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND It has long been debated whether pancreaticogastrostomy (PG) or pancreaticojejunostomy (PJ) is the better choice for reconstruction after pancreaticoduodenectomy. The purpose of this study is to evaluate the two techniques. METHODS Randomized controlled trials (RCTs) comparing PG with PJ published from January 1995 to January 2014 were searched electronically using PubMed, Medline, and Cochrane Library. Published data of these RCTs were analyzed using either fixed-effects model or random-effects model. RESULTS Seven RCTs were included in this meta-analysis, with a total of 1121 patients (562 in PG, 559 in PJ). The incidence of postoperative pancreatic fistula and intra-abdominal fluid collection were significantly lower in PG than in PJ (respectively: odds ratio = 0.53 [0.37, 0.74], P < 0.001; odds ratio = 0.48 [0.30, 0.76], P < 0.01), no significant difference could be found for delayed gastric emptying, hemorrhage, morbidity, reoperation rate, and mortality. CONCLUSIONS The evidence from RCTs suggests that PG technique is associated with a lower rate of postoperative pancreatic fistula and intra-abdominal fluid collection than PJ.
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Affiliation(s)
- Shijie Ma
- Department of Gastroenterology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu, P. R. China
| | - Qianjun Li
- Department of Gastroenterology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu, P. R. China
| | - Weijie Dai
- Department of Gastroenterology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu, P. R. China
| | - Feng Pan
- Department of Gastroenterology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu, P. R. China.
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Groove Pancreatitis: Four Cases from a Single Center and Brief Review of the Literature. ACG Case Rep J 2014; 1:154-7. [PMID: 26157859 PMCID: PMC4435303 DOI: 10.14309/crj.2014.35] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 03/04/2014] [Indexed: 11/17/2022] Open
Abstract
Groove pancreatitis is a rare form of chronic pancreatitis that affects the groove anatomical area between the head of the pancreas, duodenum, and common bile duct. We provide a summary of the clinical findings of 4 groove pancreatitis cases diagnosed at a tertiary academic medical center over a 5-year period. A detailed review of the current literature surrounding this clinical entity is also provided. Although rare, groove pancreatitis should be considered in the differential diagnosis of patients presenting with pancreatic head mass lesions, as appropriate diagnosis can help avoid unnecessary surgical procedures.
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Palomeque Jiménez A, Pérez Cabrera B, Navarro Freire F, Jiménez Ríos JA. [Groove pancreatitis in the differential diagnosis of pancreatic adenocarcinoma]. Cir Esp 2014; 92:127-9. [PMID: 24314608 DOI: 10.1016/j.ciresp.2013.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 09/14/2013] [Accepted: 10/14/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Antonio Palomeque Jiménez
- Servicio de Cirugía General y del Aparato Digestivo, Unidad de Cirugía Hepatobiliopancreática, Hospital Universitario San Cecilio, Granada, España.
| | - Beatriz Pérez Cabrera
- Servicio de Cirugía General y del Aparato Digestivo, Unidad de Cirugía Hepatobiliopancreática, Hospital Universitario San Cecilio, Granada, España
| | - Francisco Navarro Freire
- Servicio de Cirugía General y del Aparato Digestivo, Unidad de Cirugía Hepatobiliopancreática, Hospital Universitario San Cecilio, Granada, España
| | - José Antonio Jiménez Ríos
- Servicio de Cirugía General y del Aparato Digestivo, Unidad de Cirugía Hepatobiliopancreática, Hospital Universitario San Cecilio, Granada, España
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Rosendahl J, Hoffmeister A, Schierle K, Maiwald B, Kahn T, Mössner J, Wittenburg H. When in doubt, take it out? Cholestasis and obstructive gastric outlet syndrome in a patient with suspected chronic pancreatitis. Pancreatology 2013; 13:458-60. [PMID: 23890148 DOI: 10.1016/j.pan.2013.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Revised: 03/22/2013] [Accepted: 04/01/2013] [Indexed: 12/11/2022]
Abstract
In some patients with tumors located in the pancreas or in the periampullary region, the decision to perform a surgical resection can be difficult. In patients with concomitant chronic pancreatitis this decision can be even more challenging, since a definitive preoperative differentiation between non-malignant and malignant tumors in many cases is not possible. Clinical symptoms or complications from the tumor often direct a rational treatment strategy. For therapeutic decisions, an interdisciplinary discussion of all diagnostic findings by experienced clinicians is needed. However, in rare cases, like the one presented here, an uncommon non-malignant entity like a periampullary hamartoma may be only diagnosed after surgical resection.
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Affiliation(s)
- Jonas Rosendahl
- Department of Internal Medicine, Neurology and Dermatology, Division of Gastroenterology and Rheumatology, University of Leipzig, Leipzig, Germany.
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