Chronic Pancreatitis with Inflammatory Mass in the Head of the Pancreas: A Special Entity?

Büchler, Markus W.; Malfertheiner, Peter; Friess, Helmut; Senn, Todd; Beger, H. G.

doi:10.1007/978-3-642-75319-0_6

Cited by 13 publications

(5 citation statements)

References 7 publications

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“…The presence of local complications is distinct and a defining feature in patients with inflammatory mass of the pancreas, which was interestingly similar to a series reported 30 years back (46% bile duct obstruction, 30% duodenal obstruction, and 15% vascular involvement). 2 Furthermore, almost a quarter of patients have 29 Thus, both the need and choice of surgery is significantly influenced by the initial diagnostic workup and must hence be pursued in all patients depending on clinical presentation.…”

Section: Discussionmentioning

confidence: 99%

“…Chronic pancreatitis is a pathologic fibro-inflammatory syndrome of the pancreas in individuals with genetic, environmental, and/or other risk factors who develop persistent pathologic responses to parenchymal injury or stress 1 . A small subgroup of CP patients (5%–10%) present as mass lesions, most commonly in the head region of the pancreas, 2 which may either be inflammatory (inflammatory head mass of pancreas [IMP]) or neoplastic, most frequently pancreatic ductal adenocarcinoma (PDAC). This differentiation is particularly important because the patients with CP are also at approximately 15 times higher risk of pancreatic cancer 3 .…”

Section: Summary Boxmentioning

confidence: 99%

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Combination of Serum CA 19-9 and Endoscopic Ultrasound Findings Can Predict Malignancy Risk in Patients With Chronic Pancreatitis Presenting With Pancreatic Head Mass

Agarwal,

Gunjan,

Gopi

et al. 2023

Pancreas

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Background and Aims Inflammatory head mass of pancreas (IMP) developing in background of chronic pancreatitis (CP) is difficult to distinguish from carcinoma pancreas. We aimed to delineate natural course of IMP and predict their malignancy risk, avoiding unnecessary biopsies. Materials and Methods In this retrospective single-center study, clinical records of patients with CP with diagnosed pancreatic head mass were reviewed. Clinical, laboratory, imaging, endoscopic findings, and follow-up details were retrieved from prospectively maintained database. A diagnostic nomogram was developed combining serum cancer antigen 19-9 and endoscopic ultrasound (EUS) findings to predict the risk of malignancy. Results We identified 107 patients with pancreatic head mass with CP of whom 87 (81.3%) were IMP and 20 (18.7%) were malignant. Patients with IMP were more frequently young males with alcohol-related CP and low CA 19-9 in comparison with those with malignancy (age IMP: 41.3 ± 11.3 vs carcinoma: 49.3 ± 14.5 years [P = 0.009]; males 89.7% vs 65% [P = 0.011]; alcoholic etiology: 71.3% vs 20% [P < 0.001]; median CA 19-9: 25.78 [interquartile range, 7.20–120.60] vs 1034.50 [106.65–7808.25] [P < 0.001]). A diagnostic nomogram combining CA 19-9 and EUS findings could identify malignancy with an optimism-corrected c-statistic of 0.905, which was better than both CA 19-9 (0.80) and EUS alone (0.826). Patients with IMP had relatively benign disease course with 40.2% biliary obstruction, 20.7% portal venous thrombosis, 14.9% gastric outlet obstruction, and 1-, 3-, and 5-year survival being 97.3%, 92.7%, and 92.0%, respectively. Surgery was required in only 12 patients (13.8%) with IMP. Conclusions Combination of CA 19-9 and EUS best identifies malignancy risk in patients with IMP, who have otherwise benign course.

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Section: Discussionmentioning

confidence: 99%

Section: Summary Boxmentioning

confidence: 99%

Combination of Serum CA 19-9 and Endoscopic Ultrasound Findings Can Predict Malignancy Risk in Patients With Chronic Pancreatitis Presenting With Pancreatic Head Mass

Agarwal,

Gunjan,

Gopi

et al. 2023

Pancreas

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“…A sub group of patients with CP suffer from an inflammatory mass in the head of the pancreas [23,24] . These mass lesions present great diagnostic and therapeutic dilemas and malignancy needs to be ruled out with certainty.…”

Section: Discussionmentioning

confidence: 99%

Predictors of malignancy in chronic calcific pancreatitis with head mass

Perumal

Palaniappan²,

Sa³

et al. 2013

WJGS

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AIM:To prospectively analyse the clinical, biochemical and radiological characteristics of the mass lesions arising in a background of chronic calcific pancreatitis (CCP). METHODS:Eighty three patients, who presented with chronic pancreatitis (CP) and a mass lesion in the head of pancreas between February 2005 and December 2011, were included in the study. Patients who were identified to have malignancy underwent Whipple' s procedure and patients whose investigations were suggestive of a benign lesion underwent Frey's procedure. Student t -test was used to compare the mean values of imaging findings [common bile duct (CBD), main pancreatic duct (MPD) size] and laboratory data [Serum bilirubin,] between the groups. Receiver operating characteristic curve (ROC curve) analysis was done to calculate the cutoff valves of serum bilirubin, CA 19-9, MPD and CBD size. The sensitivity, specificity, positive predictive valve (PPV) and negative predictive value (NPV) were calculated using these cut off points. Multivariate analysis was performed using logistic regression model. RESULTS:The study included 56 men (67.5%) and 27 women (32.5%). Sixty (72.3%) patients had tropical calcific pancreatitis and 23 (27.7%) had alcohol related CCP. Histologically, it was confirmed that 55 (66.3%) of the 83 patients had an inflammatory head mass and 28 (33.7%) had a malignant head mass. The mean age of individuals with benign inflammatory mass and those with malignant mass was 38.4 years and 45 years respectively. Significant clinical features that predicted a malignant head mass in CP were presence of a head mass in CCP of tropics, old age, jaundice, sudden worsening abdominal pain, gastric outlet obstruction and significant weight loss (P ≤ 0.05). The ROC curve analysis showed a cut off value of 5.8 mg/dL for serum bilirubin, 127 U/mL for CA 19-9, 11.5 mm for MPD size and 14.5 mm for CBD size. CONCLUSION:Elevated Serum bilirubin and CA 19-9, and dilated MPD and CBD were useful in predicting malignancy in patients with CCP and head mass.

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“…Approximately 30% of patients with chronic pancre atitis develop an enlargement of the pancreatic head which can lead to complications such as common bile duct obstruction, obstruction of the main pancreatic duct, vascular obstruction and duodenal compression, all of which represent an indication for surgical treatment [53,54], In the past, the classical Whipple procedure and sub sequently its modification -the pylorus-preserving Whip ple -have served as the standard operations for treating these patients, even though the long-term success of these procedures in patients with chronic pancreatitis has not been convincing [4][5][6], Recently, the appropriateness of these surgical techniques in the treatment of chronic pan creatitis has been questioned. Thus the objective of our randomized, controlled trial comparing the pylorus-pre serving Whipple operation with the duodenum-preserv ing pancreatic head resection was to determine whether there is a demonstrable advantage in the preservation of the duodenum for patients with chronic pancreatitis, especially in light of the fact that the duodenum plays a central role in the postprandial regulation of the digestive process [50,55],…”

Section: Discussionmentioning

confidence: 99%

Which Is the Better Operation in Chronic Pancreatitis: Pylorus-Preserving Whipple or Duodenum-Preserving Pancreatic Head Resection?

Friess¹,

Müller²,

Büchler³

1996

Dig Surg

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Surgical treatment in patients suffering from chronic pancreatitis is still discussed controversially. The classical Whipple resection which has been the standard operation in chronic pancreatitis for several decades is continuously replaced by organ-preserving surgical procedures. The pylorus-preserving Whipple resection, a modification of the classical Whipple, and the duodenum-preserving pancreatic head resection are two competitive operations in patients with chronic pancreatitis and pancreatic head-related complications. A randomized, controlled clinical trial comparing duodenum-preserving pancreatic head resection and pylorus-preserving Whipple resection shows that duodenum-preserving pancreatic head resection can be carried out in chronic pancreatitis with morbidity and mortality similar to that of the pylorus-preserving Whipple procedure. Furthermore, this study demonstrates the superiority of the duodenum-preserving pancreatic head resection with regard to postoperative quality of life and glucose metabolism, which are responsible for faster weight gain and convalescence. Delayed gastric emptying and biliary fistulae, which may lead to morbidity following pylorus-preserving Whipple, do not occur after duodenum-preserving pancreatic head resection. We conclude from these data that, in comparison with the pylorus-preserving Whipple resection, the duodenum-preserving pancreatic head resection provides better early postoperative outcome and convalescence as well as better preservation of the endocrine function, and should therefore be adopted as a new standard procedure in the treatment of pancreatic head complications in chronic pancreatitis.

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Chronic Pancreatitis with Inflammatory Mass in the Head of the Pancreas: A Special Entity?

Cited by 13 publications

References 7 publications

Combination of Serum CA 19-9 and Endoscopic Ultrasound Findings Can Predict Malignancy Risk in Patients With Chronic Pancreatitis Presenting With Pancreatic Head Mass

Combination of Serum CA 19-9 and Endoscopic Ultrasound Findings Can Predict Malignancy Risk in Patients With Chronic Pancreatitis Presenting With Pancreatic Head Mass

Predictors of malignancy in chronic calcific pancreatitis with head mass

Which Is the Better Operation in Chronic Pancreatitis: Pylorus-Preserving Whipple or Duodenum-Preserving Pancreatic Head Resection?

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