Retrospective Study
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World J Gastroenterol. Jul 14, 2014; 20(26): 8612-8616
Published online Jul 14, 2014. doi: 10.3748/wjg.v20.i26.8612
Follow-up of patients with pseudotumoral chronic pancreatitis: Outcome and surveillance
Félix Ignacio Téllez-Ávila, Álvaro Villalobos-Garita, Marc Giovannini, Carlos Chan, Jorge Hernández-Calleros, Luis Uscanga, Miguel Ángel Ramírez-Luna
Félix Ignacio Téllez-Ávila, Miguel Ángel Ramírez-Luna, Endoscopy Department, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Mexico City, CP 14000, México
Álvaro Villalobos-Garita, Gastroenterology Department, Hospital Calderón Guardia, CCSS, San José, CP 10105, Costa Rica
Marc Giovannini, Endoscopic Unit, Paoli-Calmettes Institute, 232 Bd St-Marguerite, 13273 Marseille cedex 9, France
Carlos Chan, Surgery Department, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Mexico City, CP 14000, México
Jorge Hernández-Calleros, Luis Uscanga, Gastroenterology Department, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Mexico City, CP 14000, México
Author contributions: Téllez-Ávila FI design the report; Téllez-Ávila FI, Villalobos-Garita A, Chan C, Hernández-Calleros J, Uscanga L, and Ramírez-Luna MÁ were attending doctors for patients; Téllez-Ávila FI and Ramírez-Luna MÁ performed endoscopies; Téllez-Ávila FI, Villalobos-Garita A, Hernández-Calleros J, Chan C, and Giovannini M organized the report; and Téllez-Ávila FI, Villalobos-Garita A, and Giovannini M wrote the paper.
Correspondence to: Félix Ignacio Téllez-Ávila, MD, MSc, PhD, Endoscopy Department, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Vasco de Quiroga 15. Col. Sección XVI. Del. Tlalpan, Mexico City, CP 14000, Mexico. felixtelleza@gmail.com
Telephone: +525-54-870900 Fax: +525-54-870900
Received: November 26, 2013
Revised: February 14, 2014
Accepted: April 5, 2014
Published online: July 14, 2014
Processing time: 230 Days and 4.9 Hours
Abstract

AIM: To follow up patients with pseudotumoral chronic pancreatitis (PCP) to assess their outcome and identify an optimal surveillance interval.

METHODS: Data obtained prospectively were analyzed in a retrospective manner. Patients with clinical evidence of chronic pancreatitis (abdominal pain in the epigastrium, steatorrhea, and diabetes mellitus), endoscopic ultrasound (EUS) criteria > 4, and EUS-fine needle aspiration (FNA) were included. A pseudotumor was defined as a non-neoplastic space-occupying lesion, a cause of chronic pancreatitis that may mimic changes typical of pancreatic cancer on CT or endoscopic ultrasound but without histological evidence. A real tumor was defined as a neoplastic space-occupying lesion because of pancreatic cancer confirmed by histology.

RESULTS: Thirty-five patients with chronic pancreatitis were included, 26 (74.2%) of whom were men. Nine (25.7%) patients were diagnosed with pseudotumoral chronic pancreatitis and two (2/35; 5.7%) patients with pseudotumoral chronic pancreatitis were diagnosed with pancreatic cancer on follow-up. The time between the diagnosis of pseudotumoral chronic pancreatitis and pancreatic adenocarcinoma was 35 and 30 d in the two patients. Definitive diagnosis of pancreatic adenocarcinoma was made by surgery. In the remaining six patients with pseudotumoral chronic pancreatitis, the median of follow-up was 11 mo (range 1-22 mo) and they showed no evidence of malignancy on surveillance. In the follow-up of patients without pseudotumoral chronic pancreatitis but with chronic pancreatitis, none were diagnosed with pancreatic cancer. According to our data, older patients with chronic pancreatitis are at risk of pseudotumoral chronic pancreatitis.

CONCLUSION: According to characteristics of patient, detection of PCP should lead a surveillance program for pancreatic cancer with EUS-FNA in < 1 mo or directly to surgical resection.

Keywords: Chronic pancreatitis; Pseudotumoral chronic pancreatitis; Surveillance; Endoscopic ultrasound

Core tip: Actually, there are no clear recommendations for follow-up of patients with chronic pancreatitis and solid pancreatic mass lesions. We followed-up patients with chronic pancreatitis and solid pancreatic mass lesions and we assessed the final outcome and identified an optimal surveillance interval. We found that almost one-third of patients with chronic pancreatitis had pseudotumoral chronic pancreatitis, and 22.2% had unresectable pancreatic adenocarcinoma less than 2 mo after the initial diagnosis. Endoscopic ultrasound fine needle aspiration can miss malignancy in nearly 25% of patients with pseudotumoral chronic pancreatitis.