The clinical feature and outcome of groove pancreatitis in a cohort: A single center experience with review of the literature

Abstract

Background: Groove pancreatitis (GP) is a rare form of chronic pancreatitis that is less common and is now gaining awareness with multimodal imaging modalities. Our aim is to analyze the mid-long term outcomes of patients diagnosed with GP with different treatment approaches.

Methods: A computerized search from electronic patient record database between May 2013 and June 2019 with the keywords 'groove', 'paraduodenal' was applied. The clinical, radiological and pathological data of 25 patients diagnosed with GP were obtained.

Results: In the GP patient group, the median age was 55 (25-87) and 80% was male. Alcohol and tobacco abuse was 40% among GP patients. The most common symptoms were upper abdominal pain (84%) and nausea-vomiting (40%), respectively. Gastric outlet obstruction was observed in 4 (16%) patients. CT and EUS imaging were performed to majority of cases (96% and 92 %, respectively). EUS-FNA was done in 14 of 25 (56%) patients. It was reported as atypia, adenocarcinoma and benign in 2 (8%), 2 (8%) and 10 (40%) patients, respectively. EUS-FNA was helpful to diagnose two pancreatic head adenoCA whose preliminary radiological evaluation was GP. The mean follow-up period was 29 (3-71) months. Conservative approach was the predominantly preferred treatment (%56). Apart from conservative approach, treatment strategies included biliary stenting, sphincterotomy, wirsung stenting via ERCP, cholecystectomy etc. Considering all treatment modalities, symptoms improved in 12 (48%) patients and progressed with recurrent pancreatitis attacks in 7 (28%) patients.

Conclusion: Because GP is a less well-known form of pancreatitis, it presents several challenges for clinicians in diagnosis and treatment. This form, which can mimic pancreatic malignancy in particular, must be differentiated from carcinoma. EUS(±FNA) is a useful diagnostic tool complementary to imaging. Although the conservative approach remains the first choice in most patients, the clinician should consider invasive endoscopic procedures and surgical options in special cases when necessary.

Figure 1

In the coronal and axial T2-weighted MR images, Soft tissue thickening with cystic openings (blue arrows) within the head of the pancreas and 2^nd part of the duodenum localization was interpreted as GP, but noticeably high levels of CA 19-9 prompted a suspicion of malignancy and EUS –FNA revealed a pancreatic head carcinoma.

Figure 2

EUS pictures of a sixty years-old gentleman presented with abdominal pain, nausea and vomiting (a-d). The arrows indicating; a. Significantly thickened duodenal wall in groove area (b). Pancreatic Head appears completely normal. (c) Cystic areas of various sizes in the thickened wall-characteristic finding of groove pancreatitis (d). Aspirated fluid from inramural cyst revealed Amylase 51625 U/L, Glukoz: 70 mg/dl, Total kolestrol: 75 mg/dl, CEA: 229 ng/ml, CA 19.9:65541 U/ml.