Groove Pancreatitis: Endoscopic Treatment via the Minor Papilla and Duct of Santorini Morphology
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background/Aims: Groove pancreatitis (GP) is an uncommon disease involving the pancreaticoduodenal area. Possible pathogenesis includes obstructive pancreatitis in the duct of Santorini and impaired communication with the duct of Wirsung, minor papilla stenosis, and leakage causing inflammation. Limited data regarding endoscopic treatment have been published. Methods: Seven patients with GP receiving endoscopic treatment were reviewed. The morphology of the pancreatic duct was evaluated by a pancreatogram. Endoscopic dilation of the minor papilla and drainage of the duct of Santorini were performed. Results: There were two pancreatic divisum cases, one ansa pancreatica case and four impaired connections between the duct of Santorini and the main pancreatic duct. Three to 31 sessions of endoscopy, with 2 to 24 sessions of transpapillary stenting and dilation, were performed. Interventions through the minor papilla were successfully performed in six of seven cases. The pancreatic stenting duration ranged from 2 to 87 months. Five patients with evidence of chronic pancreatitis (CP) tended to receive more endoscopic interventions than did the two patients without CP (2–24 vs 2, respectively) for GP and other complications associated with CP. Conclusions: Disconnection or impairment of communication between the ducts of Santorini and Wirsung was observed in all cases of GP. No surgery was required, and endoscopic minor papilla dilation and drainage of the duct of Santorini were feasible for the treatment of GP.
Abstract
Background/Aims: Groove pancreatitis (GP) is an uncommon disease involving the pancreaticoduodenal area. Possible pathogenesis includes obstructive pancreatitis in the duct of Santorini and impaired communication with the duct of Wirsung, minor papilla stenosis, and leakage causing inflammation. Limited data regarding endoscopic treatment have been published. Methods: Seven patients with GP receiving endoscopic treatment were reviewed. The morphology of the pancreatic duct was evaluated by a pancreatogram. Endoscopic dilation of the minor papilla and drainage of the duct of Santorini were performed. Results: There were two pancreatic divisum cases, one ansa pancreatica case and four impaired connections between the duct of Santorini and the main pancreatic duct. Three to 31 sessions of endoscopy, with 2 to 24 sessions of transpapillary stenting and dilation, were performed. Interventions through the minor papilla were successfully performed in six of seven cases. The pancreatic stenting duration ranged from 2 to 87 months. Five patients with evidence of chronic pancreatitis (CP) tended to receive more endoscopic interventions than did the two patients without CP (2–24 vs 2, respectively) for GP and other complications associated with CP. Conclusions: Disconnection or impairment of communication between the ducts of Santorini and Wirsung was observed in all cases of GP. No surgery was required, and endoscopic minor papilla dilation and drainage of the duct of Santorini were feasible for the treatment of GP.
참고문헌 (15)
- Becker V, "Groove pancreatitis", Int J Pancreatol, 10, pp.173~182 (1991)
- Adsay NV, "Paraduodenal pancreatitis: a clinicopathologically distinct entity unifying cystic dystrophy of heterotopic pancreas para-duodenal wall cyst and groove pancreatitis", Semin Diagn Pathol, 21, pp.247~254 (2004)[DOI]
- Arvanitakis M, "Endotherapy for paraduodenal pancreatitis: a large retrospective case series", Endoscopy, 46, pp.580~587 (2014)[DOI]
- Isayama H, "Successful treatment for groove pancreatitis by endoscopic drainage via the minor papilla", Gastrointest Endosc, 61, pp.175~178 (2005)[DOI]
- Kager LM, "Outcomes after conservative, endoscopic, and surgical treatment of groove pancreatitis: a systematic review", J Clin Gastroenterol, 51, pp.749~754 (2017)[DOI]
- Shimosegawa T, "The revised Japanese clinical diagnostic criteria for chronic pancreatitis", J Gastroenterol, 45, pp.584~591 (2010)[DOI]
- Lekkerkerker SJ, "Clinical outcomes and prevalence of cancer in patients with possible groove pancreatitis", J Gastroenterol Hepatol, 31, pp.1895~1900 (2016)[DOI]
- Oza VM, "Groove pancreatitis, a masquerading yet distinct clinicopathological entity: analysis of risk factors and differentiation", Pancreas, 44, pp.901~908 (2015)[DOI]
- Shudo R, "Segmental groove pancreatitis accompanied by protein plugs in Santorini's duct", J Gastroenterol, 33, pp.289~294 (1998)[DOI]
- Casetti L, "Paraduodenal pancreatitis: results of surgery on 58 consecutives patients from a single institution", World J Surg, 33, pp.2664~2669 (2009)[DOI]
- Sasahira N, "Outcomes after clearance of pancreatic stones with or without pancreatic stenting", J Gastroenterol, 42, pp.63~69 (2007)[DOI]
- Fujimori N, "Endoscopic approach through the minor papilla for the management of pancreatic diseases", World J Gastrointest Endosc, 5, pp.81~88 (2013)[DOI]
- Yamamoto N, "Endoscopic minor papilla balloon dilation for the treatment of symptomatic pancreas divisum", Pancreas, 43, pp.927~930 (2014)[DOI]
- Brown NG, "Minor papilla endotherapy in patients with ventral duct obstruction: identification and management", Gastrointest Endosc, 85, pp.365~370 (2017)[DOI]
- Wagner M, "Cystic form of paraduodenal pancreatitis (cystic dystrophy in heterotopic pancreas (CDHP)): a potential link with minor papilla abnormalities? A study in a large series", Eur Radiol, 26, pp.199~205 (2016)[DOI]