Endoscopic Ultrasound in the Diagnosis of Pancreatoduodenal Groove Pathology: Report of Three Cases and Brief Review of the Literature

Abstract

The pancreatoduodenal groove is a small area where pathologic processes involving the distal bile duct, duodenum, pancreatic head, ampulla of Vater, and retroperitoneum converge. Despite great advances in imaging techniques, a definitive preoperative diagnosis is challenging because of the complex anatomy of this area. Therefore, surgical intervention is frequently required because of the inability to completely exclude malignancy. We report 3 cases of patients with different groove pathologies but similar clinical and imaging presentation, and show the essential role of endoscopic ultrasound (EUS) in making a specific preoperative diagnosis, excluding malignancy in the first case, changing diagnosis in the second case, and confirming malignancy in the third case. EUS was a fundamental tool in this cohort of patients, not only because of its ability to provide superior visualization of a difficult anatomical region, but because of the ability to guide precise, real-time procedures, such as fine-needle aspiration.

Groove pancreatitis presenting with upper gastrointestinal obstruction and abnormal renal function: A case report and literature review

“…The lesion is poorly delineated from the duodenum and pancreatic head, and cystic changes of varying sizes may be present in the lesion or within the duodenal wall. Fine needle aspiration under EUS can aid in the diagnosis (23,24). It can be challenging to distinguish GP from other conditions such as duodenal tumors, bile duct cancer, periampullary carcinoma and pancreatic cancer, particularly in the early stages of the disease (9,25).…”

Diagnostic value of endoscopic ultrasound in groove pancreatitis

“…In highly suspected cases of GP, EUS - FNA was performed on the abnormally thickened duodenal wall and groove area, revealing only inflammatory changes and no malignant or poorly developed cells; this largely ruled out the possibility of malignant tumors [ 9 , 13 ]. For patients with imaging findings highly suggestive of GP and clinical suspicion of malignant tumors, EUS - FNA examination before formulating treatment plans usually provides satisfactory results [ 10 ].…”

Groove Pancreatitis: Clinical Cases and Review of the Literature

“…Imagiological findings include fibrotic changes of the pancreatic groove and the presence of duodenal wall cysts as well as the thickening of the duodenal wall, pancreatic head enlargement, CBD, and Wirsung duct stricture. Given the clinical and radiological resemblance to pancreatic cancer, the diagnosis is challenging and frequently requires surgical intervention [ 5 , 6 ]. We report two cases of GP as well as a review of the literature.…”