Follow-up of patients with pseudotumoral chronic pancreatitis: Outcome and surveillance

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.