Diagnostic value of endoscopic ultrasound in groove pancreatitis

Figures & data

Figure 1. Pancreatic duct dilation, multiple stones and chronic pancreatitis with the possibility of formation of pancreatic head pseudocysts.

Figure 2. Pancreatic duct dilation, multiple stones and chronic pancreatitis with the possibility of formation of pancreatic head pseudocysts.

Table 1. Different imaging and endoscopic features of suspected cases of GP with other causes cannot be ruled out.

Characteristics	Clinical feature	CT	MRI/MRCP	EUS	EUS-FNA	Final outcome
A 37-year-old male [9]	Dull aching epigastric and vomiting	A soft tissue lesion between the duodenum and the pancreatic head, possibly adenocarcinoma of the pancreas		Thickening of the descending duodenal wall with two small cysts .There was also some heterogeneity and stranding in the groove between the pancreatic head and duodenum; the rest of the pancreas was free	Only inflammatory changes, and no malignant or dysplastic cells	GP
A 72-year-old woman [10]	Weight loss and epigastric pain	Non-dilated biliary tract, atrophic pancreatic gland with a globular head, uncinate process and calcifications and concentric parietal thickening at the level of the second part of the duodenum. The surrounding fat was altered, especially in the groove area, and was associated with a fine fluid band		Pancreas with normal echogenicity without focal lesions. At the level of the first and second part of the duodenum, EUS revealed a semi-circumferentially-thickened duodenal wall with disruption of the layered configuration	Mucosa with edema and reactive changes, but no atypical cells	High-dose omeprazole was prescribed for 8 weeks with good clinical response and normalization of radiological and endoscopic images after 2 months
A 72-year-old male smoker [10]	Chronic epigastric pain, weight loss and obstructive jaundice	Biliary tract dilation without identification of the terminal portion, where a change in caliber was noted with wall enhancement. Thickening of the duodenum wall was observed, with three intraparietal cystic images and a hypodense tissue interposed between the pancreas and duodenum. The pancreas was slightly diminished in size, with adequate enhancement with intravenous contrast		A hypoechoic heterogeneous cephalic mass compromising the duodenal wall, which was thickened by the presence of three intraparietal cysts. The bile duct and the pancreatic duct were dilated	A typical tumor proliferation and cells with variable degrees of anisokaryosis in an inflammatory environment	Pancreatic adenocarcinoma with infiltration of the duodenal submucosa and tumor-free surgical margins (T3N1-M0)
A 57-year-old man [2]	Sharp epigastric pain with associated nausea and vomiting	A high-grade obstruction of the second portion of the duodenum without any obvious mass	An ill-defined soft tissue mass in the region of the pancreatic head and descending duodenum with tethering of the duodenum causing obstruction	A 3 cm hypoechoic mass in the region of the pancreatic head with irregular borders and no vascular invasion	No obvious abnormalities found	GP
A 47-year-old man with a history of alcohol abuse [11]	Right upper-quadrant abdominal pain and weight loss	Bulky head and uncinate process of pancreas with a hypodense area between the pancreatic head and second part of the duodenum, prominent pancreatic duct, dilated common bile duct, hugely distended gall bladder, irregular wall thickening of the first and second parts of the duodenum with stenosis of the second part		EUS confirmed CT findings	Only inflammatory infiltrate and no malignancy	GP
A 47-year-old man with a history of alcohol abuse [12]	Epigastric pain and significant weight loss		A prominent postcontrast T1 delayed-enhancing mass in the region of the minor papilla, centered adjacent to the duodenal wall	A round, intramural, hypoechoic lesion with poorly defined outer margins, located in the second portion of the duodenum	Normal glandular cells and local inflammation	Segmental GP
A 45-year-old smoker with a history of alcohol abuse [13]	Epigastric pain and weight loss	Duodenal wall thickening with luminal narrowing without parenchymal calcifications or cysts. The body and tail of the pancreas were healthy with some pericephalic pancreatic and periduodenal lymphadenopathy		Mass-like growth of the pancreatic head, narrowed duodenal wall and associated stenosis, but revealed no CBD stricture or dilatation of the pancreatic duct system	Inflammatory changes with no malignant or dysplastic cells	Treated by conservative medical measures and experienced no further symptoms for six months

Table 2. EUS performance of GP patients.

	Accuracy (%)	Sensitivity (%)	Specificity (%)	Positive predictive value (%)	Negative predictive value (%)
EUS
Pancreatic head enlargement	57	–	–	–	–
Duodenal wall thickening	76.2–96.5	–	–	–	–
Duodenal wall cyst	52.4–94.4	–	–	–	–
EUS-FNA	95.65	90	100	100	92.86

Figure 3. The pancreatic body and tail parenchyma appear atrophic, patchy calcification can be seen at the head of the pancreas, and multiple anechoic structures can be seen on the side of the pancreatic head. The adjacent duodenal wall is thickened with cysts of the duodenal wall.

Figure 4. Narrow lumen of the descending segment of the duodenum, a hypoechoic mass seen at the pancreatic head, compression of the adjacent duodenal wall and unclear local boundary with the duodenal wall.

Table 3. Studies according to type of treatment (surgical versus endoscopic versus medical treatment).

Author	Year	No. of patients	Neither medical nor surgical n (success %)	Medical n (success %)	Endoscopy n (success %)	Surgery n (success %)
Fléjou et al. [4]	1993	10	–	–	–	10 (100%)
Pessaux et al. [28]	2006	–	——	7 (0)	4 (0)	12 (66.7%)
Jouannaud et al. [29]	2006	23	3	20 (75%)	2 (0)	14 (64.3%)
Tison et al. [30]	2007	9	–	–	–	9 (88.9%)
Rahman et al. [31]	2007	11	–	–	–	11 (100%)
Rebours et al. [32]	2007	105	19	86	16 (37.5%)	29 (93.1%)
Jovanovic et al. [33]	2008	13	–	4 (0)	–	13
Casetti et al. [34]	2009	58	–	–	–	58 (76%)
Kim et al. [35]	2011	6	–	–	–	6 (66.7%)
Levenick et al. [36]	2012	5	–	–	–	5 (100%)
Arvanitakis et al. [37]	2014	51	–	24 (20%)	42 (71.4)	12
Egorov et al. [38]	2014	62	–	60	1	52 (76.9%)
Zaheer et al. [39]	2014	12	–	–	–	12 (0)
Arora et al. [40]	2015	33	–	33 (97%)	–	1
Lekkerkerker et al. [41]	2016	28	–	14 (85.7%)	9 (88.9%)	8 (87.5%)
de Pretis et al. [42]	2017	120	–	116 (85.3%)	–	81 (72.8%)
Aguilera et al. [43]	2018	8	–	–	–	8 (75%)
Chantarojanasiri et al. [44]	2018	7	–	7 (0)	7 (100%)	0
Ooka et al. [45]	2020	48	–	48 (85.4%)	–	7
Balduzzi et al. [46]	2020	75	–	65	11	47
Tarvainen et al. [47]	2021	33	–	30	16	9
Egrov et al. [48]	2021	84	–	84	–	72 (59.7%)
Teo et al. [49]	2022	8	–	–	–	8 (87.5%)
Deg˘er et al. [50]	2022	25	–	14	14	1
Kulkarni et al. [51]	2022	30	–	26	3	4
Dhali et al. [52]	2022	9	–	–	–	9 (44.4%)
Vujasinovic et al. [53]	2022	35	–	35 (48.6%)	9 (77.8%)	5 (80%)

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