Introduction

Paraduodenal pancreatitis (PP) is a particular form of chronic pancreatitis that affects an area, defined by some authors as "groove", between the head of the pancreas, the duodenum and the main biliary tract. [1] The two forms of PP, the cystic and the “solid” form, [2] may extend to the adjacent pancreatic tissue and the entire main pancreatic duct, causing chronic obstructive pancreatitis ("diffuse" form), leading to heterogeneous clinical presentations.[3,4] Pathogenesis and natural history is still unclear, even if it has been linked to exogenous factors, especially alcohol and smoking, and the treatment include both medical therapy and surgery [5].

Aims & Methods

We performed a multicentre retrospective observational study to explore the burden of the disease, and its evolution towards exocrine pancreatic insufficiency(EPI) considering also the risk of neoplastic evolution. We collected data from both academic and non-academic Italian centers. All patients with diagnosis of PP were included in the registry. Data were extracted at the time of diagnosis and during follow-up. Univariate and multivariate analysis were performed to explore the relations between variables and outcomes of interest.

Results

208 patients(87.5% male) from 16 centres were collected into our national registry. Mean age at diagnosis was 51(± 11) years and mean time from clinical presentation to diagnosis was 18(±29) months. 88.4% had history of alcohol abuse and 89% of smoking. 36 patients(17.9%) had diabetes at diagnosis, while 80 patients (41.5%) had chronic pancreatitis. Clinical presentation included abdominal pain(89.1%), jaundice(18.5%), nausea(47.1%) and vomiting(32.6%). Initial laboratory tests showed a mean increase of bilirubin of 1.62(±1.7) times upper limit of normal(ULN), Amylase 2.9(±2.5) times ULN, Lipase 3.2(±3.1) times ULN. 6(3%) patients developed pancreatic cancer after a mean time of 10.3(±10.8) months from PP diagnosis. 49 patients(23.6%) had EPI at diagnosis , while further 49 patients developed it during follow up. Among patients with EPI at diagnosis, 19(38.8%) recovered with no more signs of EPI at the last follow up. Preliminary analyses showed that EPI at diagnosis was associated to EPI at the last follow up(OR 2.6, p=0.012). Mean time to develop EPI was 17.1(±23.5) months. Conservative treatment was the treatment of choice in 54.3% cases, surgery in 17.3% and endoscopic therapy in 16.35% cases. Over a median follow-up of 36 (range, 1-168) months, mortality was 4.8%.

Conclusion

Paraduodenal pancreatitis is an uncommon disease, mainly diagnosed in male patients with history of alcohol and smoking. Moreover, conservative strategy was the treatment of choice in our cohort of patients.

References

1. Adsay NV and G. Zamboni, Paraduodenal pancreatitis: a clinico-pathologically distinct entity unifying "cystic dystrophy of heterotopic pancreas", "para-duodenal wall cyst", and "groove pancreatitis". Semin Diagn Pathol 2004;21(4):247-54.
2. de Pretis N, Capuano F, Amodio A, Pellicciari M, Casetti L, Manfredi R, Zamboni G, Capelli P, Negrelli R, Campagnola P, Fuini A, Gabbrielli A, Bassi C, Frulloni L. Clinical and Morphological Features of Paraduodenal Pancreatitis: An Italian Experience With 120 Patients. Pancreas 2017;46(4):489-495.
3. Pezzilli R, Santini D, Calculli L, Casadei R, Morselli-Labate AM, Imbrogno A, Fabbri D, Taffurelli G, Ricci C, Corinaldesi R. Cystic dystrophy of the duodenal wall is not always associated with chronic pancreatitis. World J Gastroenterol 2011;17(39):4349-64.
4. López-Muñoz P, Lorenzo-Zúñiga V, Alonso-Lázaro N, et al. Endoscopic findings of paraduodenal or groove pancreatitis. Endoscopy. 2022;54(12):E735-E736. doi:10.1055/a-1773-0499
5. Balduzzi A, Marchegiani G, Andrianello S, Romeo F, Amodio A, De Pretis N, Zamboni G, Malleo G, Frulloni L, Salvia R, Bassi C. Pancreaticoduodenectomy for paraduodenal pancreatitis is associated with a higher incidence of diabetes but a similar quality of life and pain control when compared to medical treatment. Pancreatology 2020;20(2):193-198.

Introduction

Defining pancreatic steatosis (PS) and establishing its association with pancreatic cancer has been a discussed theme in the last decade. However, no consensus guidelines have yet been published on the clinical relevance and management of PS. In this systematic review and meta-analysis, we investigated the association between PS and pancreatic ductal adenocarcinoma (PDAC).

Aims & Methods

Medical literature between 2007 and 2023 was reviewed for eligible trials investigating the prevalence of PS in patients with PDAC. Eligible studies reporting on PS, assessed via imaging or histology, were included. Our primary objective was to determine the association between PDAC and PS by comparing the prevalence of PS in individuals with- and without PDAC. Subsequently, an evaluation was conducted to determine whether the method of assessment (CT, MRI, EUS or histology) and study country was correlated with the association between PS and PDAC. Measures of effect size were determined using odds ratios (ORs) and corresponding 95% confidence intervals (95% CI).

Results

The systematic review identified a total of 23 studies, of which seventeen studies examined PS prevalence among PDAC patients. Overall, the pooled prevalence of PS in patients with PDAC. was 53.6% (95% CI 40.9-66.2). No significant difference in PS prevalence was observed across various diagnostic methods or geographical regions (p= 0.71 and p= 0.50, respectively). Overall, the pooled OR for PS in in patients with PDAC compared to controls was 3.23 (95% CI 1.86-5.60, Figure 1). Subgroup analysis did not reveal any difference according to country (p= 0.52), but higher OR was observed in studies using EUS for the assessment of PS (pooled OR=6.26, 95% CI 1.23-31.8) compared to studies using CT (pooled OR=3.31, 95% CI 1.93-5.68), histology (pooled OR=1.76, 95% CI 1.22-2.54) or MRI (pooled OR=1.19, 95% CI 1.06-1.33).

Conclusion

Patients with PDAC have notable prevalence of pancreatic steatosis (53.6%). Furthermore, PDAC patients are significantly more likely to have PS (OR 3.23). These findings underscore the importance of prioritizing a standardized approach to the diagnosis, follow-up, and treatment of PS. Future studies should prioritize the identification of patients with PS who will benefit from PDAC surveillance programs.