• Bbiliary strictures
• Endoscopic treatment of biliary stricture
• pancreatitis

• Humans
• Pancreatic Ducts/diagnostic imaging
• Cholangiopancreatography, Endoscopic Retrograde/methods
• Male
• Pancreatitis/etiology
• Pancreatitis/diagnostic imaging
• Middle Aged

• Humans
• Pancreatitis/diagnosis
• Pancreatitis/etiology

• chronic pancreatitis
• groove pancreatitis
• renal dysfunction
• upper gastrointestinal obstruction

• chronic pancreatitis
• diagnostic imaging
• groove pancreatitis
• paraduodenal pancreatitis
• step-up approach

• arterial abnormality
• groove pancreatitits
• pancreatoduodenectomy
• severe fibrosis
• smoking

• Humans
• Pancreaticoduodenectomy/methods
• Aged
• Female
• Tomography, X-Ray Computed
• Pancreatitis, Chronic/surgery
• Pancreatitis/surgery
• Pancreas/abnormalities
• Pancreas/diagnostic imaging
• Pancreas/surgery

• Computerized tomography
• endoscopic ultrasound
• groove pancreatitis
• magnetic resonance imaging

• Middle Aged
• Humans
• Male
• Endosonography
• Pancreatitis, Chronic/diagnostic imaging
• Biopsy

• Groove pancreatitis
• Pancreatoduodenectomy
• Paraduodenal pancreatitis

• EUS-FNA
• groove pancreatitis

• Adenocarcinoma
• Groove
• Pancreas
• Pancreatitis
• Páncreas

• National Natural Science Foundation of China

Chronic pancreatitis (CP) is a long-lasting disease frequently associated with complications for which there is no comprehensive pathophysiological classification.

The aims of this study were to: Propose a pathophysiological classification of the complications of CP; evaluate their prevalence in a surgical cohort prior to, and following surgical management; and assess the impact of the surgical treatment on the occurrence of new complications of CP during follow-up. We hypothesized that optimal surgical treatment can resolve existing complications and reduce the risk of new complications, with the exclusion of pancreatic insufficiency. The primary outcomes were prevalence of complications of CP at baseline (prior to surgical treatment) and occurrence of new complications during follow-up.

After institutional review board approval, a prospective observational cohort study with long-term follow-up (up to 20.4 years) was conducted. All consecutive single-center adult patients (≥ 18 years of age) with CP according to the criteria of the American Pancreas Association subjected to surgical management between 1997 and 2021, were included. The prevalence of CP complications evaluated, according to the proposed classification, in a surgical cohort of 166 patients. Development of the pathophysiological classification was based on a literature review on the clinical presentation, course, and complications of CP, as well a review of previous classification systems of CP.

We distinguished four groups of complications: Pancreatic duct complications, peripancreatic complications, pancreatic hemorrhages, and pancreatic insufficiency (exocrine and endocrine). Their baseline prevalence was 20.5%, 23.5%, 10.2%, 31.3%, and 27.1%, respectively. Surgical treatment was highly effective in avoiding new complications in the first and third groups. In the group of peripancreatic complications, the 15-year Kaplan-Meier prevalence of new complications was 12.1%. The prevalence of pancreatic exocrine and endocrine insufficiency increased during follow-up, being 66.4% and 47.1%, respectively, at 15 years following surgery. Pancreatoduodenal resection resulted optimal results in avoiding new peripancreatic complications, but was associated with the highest rate of pancreatic exocrine insufficiency.

The proposed complication classification improves the understanding of CP. It could be beneficial for clinical decision making, as it provides an opportunity for more comprehensive judgement on patient’s needs on the one hand, and on the pros and cons of the treatment under consideration, on the other. The presence of complications of CP and the risk of development of new ones should be among the main determinants of surgical choice.

• Chronic pancreatitis
• Complications
• Classification
• Pathophysiology
• Surgical treatment

Groove pancreatitis (GP) is an underrecognised subtype of chronic pancreatitis, focally affecting the area between the duodenum and pancreatic head. It most commonly affects males between 40 and 50 years of age with a history of alcohol misuse. Patients most commonly complain of abdominal pain and vomiting. Due to its focal nature, it is a potentially surgically treatable form of chronic pancreatitis. We report results of patients surgically treated for groove pancreatitis followed by a literature review of patient outcomes post resection.

A retrospective chart review of patients with histopathologically confirmed GP post‐surgical resection at the Princess Alexandra Hospital and Greenslopes Private Hospital in Brisbane, Australia was conducted between 2013 and 2020. Diagnosis was confirmed histologically when Brunner gland hyperplasia and chronic inflammation/fibrosis were found within the pancreaticoduodenal interface. Preoperative and postoperative symptoms were analysed along with complications. Additionally, a systematic review on outcomes of patients undergoing pancreaticoduodenectomy (PD) for GP was performed from three databases.

Eight patients underwent surgery for GP. Elimination of preoperative symptoms was achieved in five of the eight patients. Major complications included one take back to theatre for pancreatic leak. Our literature review found complete resolution of pain and vomiting in 80% of GP patients after PD.

Optimal management of GP begins with early recognition. Symptoms from GP are likely to respond well to surgical intervention. We advocate for aggressive surgical resection in a patient with a high index of suspicion for GP.

• groove
• pancreaticoduodenectomy
• pancreatitis
• paraduodenal
• whipples

• Acute pancreatitis
• Chronic pancreatitis
• Groove pancreatitis
• Paraduodenal pancreatitis

• Adult
• Aged
• Aged, 80 and over
• Alcoholism/complications
• Cigarette Smoking/adverse effects
• Cohort Studies
• Female
• Humans
• Male
• Middle Aged
• Pancreatitis/classification
• Pancreatitis/diagnostic imaging
• Pancreatitis/pathology
• Pancreatitis/therapy
• Retrospective Studies
• Risk Factors

• R01 DK077906 NIDDK NIH HHS
• T32 DK063922 NIDDK NIH HHS
• U01 DK108306 NIDDK NIH HHS

Groove pancreatitis (GP) is a type of chronic pancreatitis occurring in an anatomic area between the duodenum, head of the pancreas, and common bile duct. Duodenal obstruction is always caused by malignant pancreatic diseases, such as pancreatic head carcinoma, while is rarely induced by benign pancreatic diseases, such as pancreatitis.

A 39-year-old man presented with a 1-mo history of upper abdominal discomfort. His concomitant symptoms were abdominal distension, postprandial nausea, and vomiting. Contrast-enhanced computed tomography of the abdomen showed thickening of the intestinal wall with enhancement of the descending segment of the duodenum, which could not be clearly differentiated from the head of the pancreas. Upper gastrointestinal radiographs and gastrointestinal endoscopy showed a complete obstruction of the descending duodenum. An operation found that a 3-cm mass was located in the “groove part” of the pancreas and oppressing the descending duodenum. Pancreaticoduodenectomy was performed to relieve the obstruction and thoroughly remove the pancreatic lesions. The pathologic diagnosis was pancreatitis. The patient had an uneventful recovery with no complications.

Because of the special location and the contracture induced by long-term chronic inflammation, our case reminds surgeons that some benign pancreatic diseases, such as GP, can also present with symptoms similar to those of pancreatic cancer. This knowledge can help to avoid an unnecessary radical operation.

• Groove pancreatitis
• Duodenal obstruction
• Pancreatic head carcinoma
• Case report