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https://doi.org/10.14309/00000434-201810001-00022
Copy DOIJournal: American Journal of Gastroenterology | Publication Date: Oct 1, 2018 |
Citations: 3 |
Introduction: Groove pancreatitis (GP) is an uncommon and distinct subset of chronic pancreatitis, involving the area between the main bile duct, head of the pancreas, and duodenum. Symptoms present with abdominal pain, obstructive jaundice, and weight loss. GP is difficult to diagnose, with imaging findings, location, and symptoms often mimicking pancreatic adenocarcinoma. Treatment revolves around medical, endoscopic, and surgical management. Rarity and difficulty in diagnosis has led to a relative paucity of data on management and outcomes, with many studies limited to less than 10 patients. We examined management and outcomes of GP at our academic center. Methods: Retrospective chart review at an academic tertiary medical center of all patients diagnosed with GP between 2008 - 2017. Pre-intervention data included: comorbidities, imaging findings, and time to intervention. Interventions were divided into surgical, ERCP, and medical management. Data on interventional morbidity, mortality, need for re-intervention, and symptom resolution was recorded based on each procedural group type. Symptoms were considered resolved if they remained absent 6 months after initial intervention. Results: A total of 24 patients with GP were identified. The demographics and comorbidities of this group is in table 1. MRI was performed in 24 (100%) patients, with chronic pancreatitis (54.1%), biliary dilatation (25%), and pancreatic duct dilatation (20.8%) being most common. For initial management: 7 patients had ERCP, 11 had surgical resection, and 6 had medical management. Breakdown by individual procedure is in table 2, with pancreatic duct stenting and Whipple procedure being the most common. 0% of ERCP patients had symptom resolution at 6 months, with 5 of 7 (71.4%) undergoing reintervention with Whipple for continued symptoms. 7 of 11 (63.6%) of initial surgical patients had sustained symptom resolution. Only 1 (9.1%) surgical patient required re-intervention. Medical management involved antiemetic therapy. 1 of 6 (16.6%) had symptom resolution and 3 of 6 (50%) eventually underwent Whipple. Morbidity occurred only in the surgical group, with 2 of 11 having peri-op infections. Conclusion: We examined a large group of patients with GP. ERCP and medical management had low rates of symptom resolution, and high re-intervention rates. Surgical options had much better rates of sustained symptom relief, but higher morbidity.22_A Figure 1. Demographics and comorbidities22_B Figure 2. MRI diagnostic findings22_C Figure 3. Management outcomes based on type of intervention
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