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
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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.
