Groove Pancreatitis Research Articles

GROOVE PANCREATITIS -A DIAGNOSTIC DILEMMA

Groove pancreatitis is a segmental chronic pancreatitis that affects the groove area, classically the anatomical area between the pancreatic head, the duodenum, and the common bile duct. The etiopathogenesis remains elusive till date, though association with alcohol abuse has been described in literature. Imaging feature described include soft tissue mass in the groove, thickening of medial wall of duodenum, thus closely mimicking a neoplastic aetiology and hence posing diagnostic dilemma. However classic ndings of cystic changes in the groove extending to duodenal wall and brotic component can aid the radiologist in making an accurate diagnosis and thus avoiding unnecessary surgical intervention. Groove pancreatitis is a disease that should be considered in the list of differential diagnosis of masses implicating the pancreatic head and medial duodenal wall.

Pancreas-preserving duodenal resections vs pancreatoduodenectomy for groove pancreatitis. Should we revisit treatment algorithm for groove pancreatitis?

BACKGROUNDThe management of cystic dystrophy of the duodenal wall (CDDW), or groove pancreatitis (GP), remains controversial. Although pancreatoduodenectomy (PD) is considered the most suitable operation for CDDW, pancreas-preserving duodenal resection (PPDR) has also been suggested as an alternative for the pure form of GP (isolated CDDW). There are no studies comparing PD and PPDR for this disease.AIMTo compare the safety, efficacy, and short- and long-term results of PD and PPDR in patients with CDDW.METHODSA retrospective analysis of the clinical, radiologic, pathologic, and intra- and postoperative data of 84 patients with CDDW (2004-2020) and a comparison of the safety and efficacy of PD and PPDR.RESULTSSymptoms included abdominal pain (100%), weight loss (76%), vomiting (30%) and jaundice (18%) and data from computed tomography, magnetic resonance imaging, and endoUS led to the correct preoperative diagnosis in 98.8% of cases. Twelve patients were treated conservatively with pancreaticoenterostomy (n = 8), duodenum-preserving pancreatic head resection (n = 6), PD (n = 44) and PPDR (n = 15) without mortality. Weight gain was significantly higher after PD and PPDR and complete pain control was achieved significantly more often after PPDR (93%) and PD (84%) compared to the other treatment modalities (18%). New onset diabetes mellitus and severe exocrine insufficiency occurred after PD (31% and 14%), but not after PPDR.CONCLUSIONPPDR has similar safety and better efficacy than PD in patients with CDDW and may be the optimal procedure for the isolated form of CDDW. The pure form of GP is a duodenal disease and PD may be an overtreatment for this disease. Early detection of CDDW provides an opportunity for pancreas-preserving surgery.

Study of role of computerized tomography (CT) in evaluation of groove pancreatitis

Background: Groove pancreatitis is a rare form of chronic pancreatitis affecting the groove between the pancreatic head, duodenum and common bile duct. The exact cause of the disease is not known, although there are strong associations with long term alcohol abuse, functional obstruction of duct of Santorini and brunner gland hyperplasia. The purpose of this study was to describe the imaging findings of groove pancreatitis (GP) on Contrast enhanced CT Abdomen. Material and Methods: Present study was retrospective study conducted, with help of medical records of 16 patients with a final diagnosis of Groove pancreatitis. CT, MRI and MRCP findings were analysed. Statistical analysis was done using descriptive statistics. Results: In present study, two types of groove pancreatitis (GP) as pure type (50%) and segmental type (50%) were noted. Other important findings were focal duodenal wall thickening (62.5%) and cysts in the duodenal wall itself or in groove between the pancreatic head and the duodenum (37.5%), CBD dilatation and distal smooth tapering (62.5%) including all the segmental types and 2 of the pure type leading to intra- and extra-hepatic biliary system dilatation. MRI and MRCP were available in 6 patients in our study. There was a CT similarity regarding the sheet of tissues within the pancreaticoduodenal groove. These were seen expressing T1 hypo-intense and T2 slightly hyperintense signal in 3 patients with depiction of mild enhancement in the delayed phases in three of them (50%). On the MDCT examinations hypodense sheet at the PD groove was seen in 12 patients with modest enhancement identified in delayed phase seen in 6 of the them. Duodenal wall thickening was seen in 10 patients while associated cysts within the duodenal wall or in PD groove were seen in 6 patients. Pancreatic head enlargement with diffuse enhancement was seen in 8 patients. Mild pancreatic duct dilatation was seen in 8 patients while dilatation of the CBD was seen in 10 patients with distal tapering and intra-hepatic biliary dilatation. Conclusion: Groove pancreatitis (GP) is a disease that should be considered in the list of differential diagnosis of masses implicating the pancreatic head and medial duodenal wall. Imaging findings that are suggestive of GP include chronic inflammatory changes with fibrosis in the PD groove with or without implication of the nearby head of the pancreas, duodenal medial mural thickening with luminal stenosis and cysts at the PD groove or within the duodenal wall.

Should we revisit treatment algorithm for the groove pancreatitis? pancreas-preserving duodenal resections vs pancreatoduodenectomy for the cystic dystrophy of the duodenal wall (Groove Pancreatitis)

Background: Management of the cystic dystrophy of the duodenal wall (CDDW), or groove pancreatitis (GP), remains controversial. Although pancreatoduodenectomy (PD) is considered as the most suitable operation for CDDW, pancreas-preserving duodenal resection (PPDR) has also been suggested as an alternative for pure form of GP (isolated CDDW). There are no studies comparing PD and PPDR for this disease. Aim: To compare the safety, efficacy, short- and long-term results of PD and PPDR in 85 patients with CDDW. Methods: A retrospective analysis of prospectively collected clinical, radiologic, pathologic, intra- and postoperative data in 85 patients with CDDW (2004-2019) and comparison of safety and efficacy of PD and PPDR was performed. Results: Symptoms: abdominal pain (100%), weight loss (76%), vomiting (30%) and jaundice (18%). The diagnosis was established by CT, MRI, and EUS. CDDW was treated conservatively(n13), by pancreatico- or cystoenterostomies(n8), by duodenum-preserving pancreatic head resections (DPPHR)(n6), by PD(n43), and PPDR(n15) without mortality. Weight gain was significantly higher after PD or PPDR compared to other treatment modalities. Сomplete pain control was achieved after PPDR (93%), PD (83%), DPPHR and draining procedures (18%each). New onset diabetes mellitus (23%) and severe exocrine insufficiency (12%) were not uncommon after PD, but never occurred after PPDR. Conclusion: Pure form of CDDW is a duodenal disease and PD is an overtreatment for it. PPDR is similar in safety and better in efficacy compared to PD in patients with CDDW and may be the optimal operation for the isolated form of CDDW. Early detection of CDDW saves pancreas.

Groove Pancreatitis in a Patient With Recurrent Abdominal Pain and History of Alcohol Misuse

Groove Pancreatitis in a Patient With Recurrent Abdominal Pain and History of Alcohol Misuse

Which Surgery Is Appropriate and Timely for the Groove Pancreatitis? Eighty Six Cases with Analysis of Different Treatment Modalities for GP

Which Surgery Is Appropriate and Timely for the Groove Pancreatitis? Eighty Six Cases with Analysis of Different Treatment Modalities for GP

Diagnosis, natural course and treatment outcomes of groove pancreatitis

BackgroundGroove pancreatitis (GP) is a rare form of chronic pancreatitis with limited data on its diagnostics and treatment outcomes. The aim of this study was to assess its diagnostics, natural course, and treatment options. MethodsThe study is a retrospective population-based study from Southern Finland, including all patients with suspected GP between January 2005 and December 2015. Two certified gastrointestinal radiologists re-reviewed the imaging studies. The radiological re-review, clinical judgment, and final histopathology confirmed the GP diagnoses. ResultsOut of 67 patients with possible GP, 39 patients were considered to have high radiological certainty of GP. Out of these 39, five patients had cancer instead. Thirty-three patients with confirmed GP formed the final study cohort. Patients with GP were mostly middle-aged (median 55 years) men. All had at least moderate alcohol consumption. No intervention was needed in 14 patients. In five-year follow-up all conservatively treated patients became asymptomatic, while 10 out of 16 patients undergoing at least one intervention were asymptomatic at five years. ConclusionThe radiological diagnosis of GP is difficult, and a low threshold for cancer suspicion should be kept. Symptoms of GP decrease with time and suggest conservative treatment as the first-line option.

Groove pancreatitis has a spectrum of severity and can be managed conservatively

Background & aimsThe natural history of groove pancreatitis is incompletely characterized. Published literature suggests a high rate of surgery. We describe the short- and long-term outcomes in a cohort of patients with groove pancreatitis treated at our institution. MethodsMedical records of patients hospitalized in the University of Pittsburgh Medical Center system from 2000 to 2014 and diagnosed with groove pancreatitis based on imaging were retrospectively reviewed. Clinical presentation and outcomes during index admission and follow-up were recorded. ResultsForty-eight patients with groove pancreatitis were identified (mean age 53.2 years, 79% male). Seventy-one percent were alcohol abusers and an equal number were cigarette smokers. Prior histories of acute and chronic pancreatitis were noted in 30 (62.5%) and 21 (43.8%), respectively. Forty-four (91.7%) met criteria for acute pancreatitis during their index admission. Alcohol was the most common etiology (68.8%). No patient experienced organ failure. The most frequent imaging findings were fat stranding in the groove (83.3%), duodenal wall thickening (52.1%), and soft tissue mass/thickening in the groove (50%). Over a mean follow-up of 5.0 years, seven (14.6%) required a pancreas-related surgery. Patients had a high burden of pancreatitis-related readmissions (68.8%, 69.4/100 patient-years). Incident diabetes and chronic pancreatitis were diagnosed in 5 (13.9% of patients at risk) and 8 (29.6% of patients at risk) respectively. ConclusionsGroove pancreatitis has a wide spectrum of severity; most patients have mild disease. These patients have a high burden of readmissions and progression to chronic pancreatitis. A small minority requires surgical intervention.

S0927 Endoscopic Ultrasound-Guided Gastrojejunostomy With a Lumen Apposing Metal Stent for Benign Diseases: An Emergent Concept

INTRODUCTION: Gastric outlet obstruction (GOO) with benign causes can be managed with percutaneous gastrojejunostomy or surgical gastrojejunal bypass, however, many patients requiring invasive intervention are high-risk surgical candidates. Endoscopic-ultrasound guided gastrojejunal bypass (EUSGJ) has emerged as a minimally invasive alternative. The procedure involves the creation of a fistula between the stomach and jejunum using EUS and placement of a lumen-apposing metal stent (LAMS) across the fistula tract. Our aim in this case series was to identify the technical and clinical success rates of EUSGJ in benign cases of GOO. METHODS: Patients who underwent EUSGJ for benign GOO over six years were included. Technical success was defined as creation of a successful gastrojejunal fistulous tract. Clinical success was defined as the ability to tolerate a diet post-procedure. RESULTS: Seventeen patients were included in the study (male: 58.8%, n = 10, mean age 57.9 y). The indication for most (82.3%) cases was groove pancreatitis. Technical success was achieved in 17 (100%) patients. Clinical success was achieved in 17 (100%) patients. Six (35.3%) patients required bridging stent placement, with 2 procedures (11.8%) converted to a natural orifice transluminal endoscopic surgery (NOTES) technique. Seventeen (100%) patients tolerated an oral diet post procedure, with majority (47.1%) tolerating a soft diet. Median procedure time was 43 minutes (range 22–189 minutes). Median hospital stay duration was 3 days (range 1–9 days). No cases encountered immediate, short-term, or long-term adverse events. CONCLUSION: EUSGJ is an emerging procedure with comparable efficacy and safety to the current gold standard therapies. Our case series demonstrated a 100% technical and clinical success rate with no post-procedural complications, a clinically relevant finding as all patients successfully avoided surgical intervention. Endoscopic-ultrasound guided gastrojejunal bypass should hold a place as a new minimally invasive option for patients with benign luminal gastrointestinal obstruction.Table 1.: Clinical Characteristics

S2336 Gastric Outlet Obstruction Caused by Groove Pancreatitis Successfully Treated With EUS-Guided Gastrojejunostomy

S2336 Gastric Outlet Obstruction Caused by Groove Pancreatitis Successfully Treated With EUS-Guided Gastrojejunostomy

Groove pancreatitis: a case report with a brief review of this diagnostic challenge.

Groove Pancreatitis is an uncommon and still under-recognized form of recurrent or chronic pancreatitis that involves the space between the pancreatic head, the duodenum and the common bile duct, the so called groove area. Its importance is that it can mimic pancreatic carcinoma, it may coexist with it or even masks it and should be considered in the differential diagnosis of pancreatic masses or duodenal stenosis. Groove Pancreatitis represents a diagnostic challenge because, from a clinical point of view, its manifestations and complications can be numerous and different from each other. Despite modern imaging techniques, even in the most specialized centers, many untrained radiologists and gastroenterologists may encounter difficulty to make the proper diagnosis. In this work, we have described a case Groove Pancreatitis manifesting as flare up of previously diagnosed chronic pancreatitis and we have tried to make a brief revision of literature concerning diagnosis and treatment of the disease.

Pancreatitis crónica del surco pancreatoduoenal: un desafío diagnóstico y terapéutico. Reporte de un caso

Groove pancreatitis is a very uncommon type of chronic pancreatitis of uncertain etiology that occurs in the pancreatoduodenal groove. Despite the great advances in imaging techniques, making a definitive diagnosis is difficult because of the complex anatomy of this area. Therefore, surgical treatment is often required due to the impossibility of excluding malignancy. We present the case of a patient with a history of chronic pancreatitis admitted due to duodenal obstruction. The diagnosis was difficult, especially for the need to exclude the neoplasms of the duodenal-pancreatic area. Endoscopic ultrasound was essential to establish a definitive diagnosis, allowing FNAP and correct assessment of the duodenal wall.

Groove pancreatitis treated by duodenal and biliary bypass

Groove pancreatitis is a type of pancreatitis where inflammation occurs in the “groove area” which is the narrow space surrounded by the duodenum, head of the pancreas and common bile duct, where lymph nodes, blood vessels and pancreatic duct exist. Groove area inflammation causes duodenal stenosis/obstruction, narrowing of the extrahepatic biliary tree and sometimes pancreatitis. The exact etiology of the disease is not well understood but Santorini duct obstruction (congenital or acquired) may be associated with inflammation of the groove area, which is partly caused by excessive alcoholic intake or gastric/duodenal peptic ulcer in adults. We report a very rare pediatric case of groove pancreatitis. The imaging findings were typical for groove pancreatitis and the bypass operation to release duodenal stenosis and extrahepatic biliary tree obstruction was performed instead of doing pancreaticoduodenectomy often done in adult cases. Groove pancreatitis is a rare disorder and a pediatric case is quite rare but pediatric surgeons should keep in mind this rare disorder when we meet the case with biliary dilatation and/or duodenal stenosis.

Groove Pancreatitis in a Patient with Agenesis of Dorsal Pancreas: A one of its kind

Groove Pancreatitis in a Patient with Agenesis of Dorsal Pancreas: A one of its kind

Groove pancreatitis: A rare case series

Groove pancreatitis (GP) is a rare type of segmental chronic pancreatitis that affects the anatomical area between the pancreatic head, the duodenum, and the common bile duct, called - “the groove area”. It remains largely an unfamiliar entity to most physicians and is often misdiagnosed as pancreatic malignancy or an autoimmune pancreatitis. We report three cases diagnosed as GP and in our department and their management. The first and second patient had recurrent episodes of abdomen pain and vomiting, while the other one was asymptomatic with steatorrhoea. The second and third patients had history of long-standing alcohol intake. First two cases underwent pancreatico-duodenectomy for intractable recurrent pain and other patient is doing well with conservative management.

EUS in the diagnosis of rare groove pancreatitis masquerading as malignancy

EUS in the diagnosis of rare groove pancreatitis masquerading as malignancy

Non-Neoplastic Masses of the Pancreas.

Benign non-neoplastic solid lesions of the pancreas are comprised of several separate entities, with their diagnostic identification best performed in correlation with the radiographic and clinical features. These include all of the pancreatitides, intrapancreatic spleen, and a few other rare entities. Preoperative imaging may suggest the correct diagnosis, but occasionally the preoperative imaging findings may be misleading because they overlap with those of pancreatic neoplasms. Masses associated with typical pancreatitides are rarely sampled due to their distinct clinical picture and relative frequency; however, the uncommon variants of pancreatitis may also present as mass lesions mimicking malignancy. Herein, we will discuss the cytopathologic findings of several solid pancreatic lesions, including acute pancreatitis, chronic pancreatitis, autoimmune pancreatitis, paraduodenal or groove pancreatitis, and other mass lesions, such as intrapancreatic accessory spleen and abscess. The key cytological features, ancillary studies, and differential diagnoses will also be discussed.

Imaging in Chronic Pancreatitis

AbstractChronic pancreatitis (CP) is a chronic progressive process which can cause irreversible damage to both the exocrine and endocrine systems of pancreas. There are various imaging modalities available to evaluate CP of which ultrasonography ( USG), computed tomography (CT), and magnetic resonance imaging (MRI) are most commonly used. USG is used as a screening modality which can show various changes of CP and its complications. However, the information obtained from USG can be limited because of the patient’s body habitus. CT is the workhorse modality which can provide comprehensive information and it is the best modality to detect calcification. MRI, on the other hand, is excellent in demonstrating the pancreatic parenchyma and the ductal system. Alcohol-related pancreatitis is the commonest cause which can show gland atrophy, ductal dilatation, and calcifications. Other less common causes include hereditary and genetic mutation–related pancreatitis. There are other special types of pancreatitis such as autoimmune pancreatitis and groove pancreatitis that have characteristic features on imaging.

Exploring the neglected segment of the intestine: the duodenum and its pathologies.

Herein we reviewed the computed tomography (CT) findings of a spectrum of pathological entities affecting the duodenum. We discuss the CT findings of some congenital, inflammatory, traumatic, and neoplastic pathologies of the duodenum along with the conventional barium studies of selected conditions. Pathologies of this C-shaped intestinal segment, derived from both foregut and midgut, are often overlooked in clinical practice and radiological literature. While congenital anomalies like duplication cysts and diverticula are usually asymptomatic, annular pancreas and malrotation may manifest in the first decade of life. Primary as well as secondary involvement of the duodenum by various disease processes can be evaluated by careful CT technique and proper attention to the duodenum. Among congenital conditions, annular pancreas, duplication cyst, superior mesenteric artery syndrome, midgut volvulus, and diverticula are presented. Duodenal involvement in adenocarcinoma, lymphoma, gastrointestinal stromal tumours, Crohn’s disease, and groove pancreatitis are discussed. Duodenal wall haematoma and traumatic duodenal perforation causing pneumoretroperitoneum in two patients after blunt trauma of the abdomen are also illustrated. CT provides superb anatomic detail and offers high diagnostic specificity for the detection of duodenal pathologies because it allows direct imaging of the intestinal wall, secondary signs of bowel disease within the surrounding mesentery, and abnormal findings in adjacent structures. Primary duodenal malignancies and local extension from adjacent malignancies can be diagnosed by CT reliably. CT also plays a vital role in the diagnosis of traumatic duodenal injury by differentiating between mural haematoma and a duodenal perforation because the latter requires immediate surgical intervention.

Pancreas-preserving duodenectomy as a treatment of choice for the isolated form of the cystic dystrophy of the duodenal wall (pure form of groove pancreatitis)

Pancreas-preserving duodenectomy as a treatment of choice for the isolated form of the cystic dystrophy of the duodenal wall (pure form of groove pancreatitis)