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Meta-Analysis
. 2024 Aug 21;24(1):278.
doi: 10.1186/s12876-024-03367-9.

Prevalence of autoimmune pancreatitis in pancreatic resection for suspected malignancy: a systematic review and meta-analysis

Zain A Karamya  1 , Attila Kovács  2 , Dóra Illés  1 , Bálint Czakó  1 , Alíz Fazekas  3 , Nelli Farkas  4 , Péter Hegyi  5 , László Czakó  6
Affiliations
Meta-Analysis

Prevalence of autoimmune pancreatitis in pancreatic resection for suspected malignancy: a systematic review and meta-analysis

Zain A Karamya et al. BMC Gastroenterol. .

Abstract

Background/objectives: Autoimmune pancreatitis (AIP) is a diagnosis-challenging disease that often mimics pancreatic malignancy. Pancreatic resection is considered to be a curative treatment for pancreatic ductal adenocarcinoma (PDAC). This meta-analysis aims to study the incidence of AIP in patients who have undergone pancreatic resection for clinical manifestation of cancer.

Methods: A comprehensive search was conducted in three databases, PubMed, Embase and the Cochrane Library, using the terms 'autoimmune pancreatitis' and 'pancreatic resection' and supplemented by manual checks of reference lists in all retrieved articles.

Results: Ten articles were included in the final analysis. 8917 pancreatic resections were performed because of a clinical suspicion of pancreatic cancer. AIP accounted for 140 cases (1.6%). Type 1 AIP comprised the majority of cases, representing 94% (132 cases), while type 2 AIP made up the remaining 6% (eight cases) after further classification. AIP accounted for almost 26% of all cases of benign diseases involving unnecessary surgery and was overrepresented in males in 70% of cases compared to 30% in females. The mean age for AIP patients was 59 years. Serum CA 19 - 9 levels were elevated in 23 out of 47 (49%) AIP patients, where higher levels were detected more frequently in patients with type 1 AIP (51%, 22 out of 43) than in those with type 2 AIP (25%, 1 out of 4). The sensitivity of IgG4 levels in type 1 AIP was low (43%, 21/49 patients).

Conclusion: Even with modern diagnostic methods, distinguishing between AIP and PDAC can still be challenging, thus potentially resulting in unnecessary surgical procedures in some cases. Serum CA 19 - 9 levels are not useful in distinguishing between AIP and PDAC. Work must thus be done to improve diagnostic methods and avoid unnecessary complicated surgery.

Keywords: Autoimmune pancreatitis; IgG4; Pancreatic cancer; Pancreatic resection; Pancreaticoduodenectomy; Whipple’s procedure.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study search and selection diagram
Fig. 2
Fig. 2
Forrest plots depicting the prevalence of type 1 and type 2 autoimmune pancreatitis in patients undergoing resection due to suspected pancreatic cancer. Size of squares for the proportion reflects the weight of the trial in the pooled analysis. The diamonds show the pooled prevalence of the types. Horizontal bars represent 95% CI. Red lines show the prediction interval
Fig. 3
Fig. 3
Forrest plots depicting the prevalence of type 1 and type 2 autoimmune pancreatitis in patients diagnosed with benign conditions following resection for suspected pancreatic cancer. Size of squares proportion reflects the weight of the trial in the pooled analysis. The diamonds show the pooled prevalence of the types. Horizontal bars represent 95% CI. Red lines show the prediction interval
Fig. 4
Fig. 4
Funnel plot of the studies included for the meta-analysis of the prevalence of type 1 and type 2 autoimmune pancreatitis in patients undergoing resection due to suspected pancreatic cancer. The funnel plot shows the logit proportion (horizontal axis) against the study size (vertical axis)
Fig. 5
Fig. 5
Funnel plot of the studies included for the meta-analysis of the prevalence of type 1 and type 2 autoimmune pancreatitis in patients diagnosed with benign conditions following resection for suspected pancreatic cancer. The funnel plot shows the logit proportion (horizontal axis) against the study size (vertical axis)
See this image and copyright information in PMC

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