Pure cystic groove pancreatitis: endosonographic appearance
02 May 2019 (online)
A 24-year-old man, who was an active smoker (20 cigarettes per day) since the age of 7 years and had a history of chronic alcohol abuse, was referred to our hospital because of recurrent mild-severe abdominal pain localized in the upper quadrants and sometimes radiating to the back. In 2012 he was hospitalized for an episode of alcoholic mild-acute pancreatitis. He then stopped drinking alcohol for 3 years, with clinical and nutritional benefits. In 2015 he began abusing alcohol again, and the abdominal pain recurred together, with progressive weight loss.
Because of the persistence of symptoms, biochemical blood tests were performed and showed a mild increase in gamma-glutamyl transferase (2 × the upper limit of normal [ULN]), amylase/lipase (2.5/1.5 × ULN), and carbohydrate antigen 19 – 9 (2 × ULN). A computed tomography scan showed the presence of a hypodense area between the head of the pancreas and the duodenal wall, which contained some cysts associated with millimetric calcifications ([Fig. 1]). A magnetic resonance imaging (MRI) scan confirmed an isointense area containing multiple small cysts ([Fig. 2]). To better clarify the nature of these findings, we performed an endoscopic ultrasound (EUS), which showed an inhomogeneous area between the head of the pancreas, the duodenum, and the common bile duct, with multiple small anechoic lesions and millimetric calcifications ([Fig. 3], [Video 1]).
Video 1 Endoscopic ultrasound view of a pure-type cystic variant of groove pancreatitis.
These findings, together with clinical and anamnestic data, are consistent with a diagnosis of the cystic variant of pure-type groove pancreatitis , a rare form of chronic pancreatitis also known as cystic dystrophy of the heterotopic pancreas, paraduodenal wall cyst, myoadenomatosis, or paraduodenal pancreatitis . EUS is now considered an important tool, together with MRI, for a diagnosis of groove pancreatitis   . However, EUS morphologic features of groove pancreatitis have not been extensively reported to date.
Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high
quality video and all contributions are
freely accessible online.
This section has its own submission
- 1 Becker V, Mischke U. Groove pancreatitis. Int J Pancreatol 1991; 10: 173-182
- 2 Adsay NV, Zamboni G. Paraduodenal pancreatitis: a clinico-pathologically distinct entity unifying “cystic dystrophy of heterotopic pancreas,” “para-duodenal wall cyst,” and “groove pancreatitis”. Semin Diagn Pathol 2004; 21: 247-254
- 3 Casetti L, Bassi C, Salvia R. et al. “Paraduodenal” pancreatitis: results of surgery on 58 consecutives patients from a single institution. World J Surg 2009; 33: 2664-2669
- 4 Jun JH, Lee SK, Kim SY. et al. Comparison between groove carcinoma and groove pancreatitis. Pancreatology 2018; 18: 805-811
- 5 Levenick JM, Gordon SR, Sutton JE. et al. A comprehensive, case-based review of groove pancreatitis. Pancreas 2009; 38: e169-175