Gabriela Kuftinec, MD, MPH
Miami, Florida
Gabriela Kuftinec, MD, MPH1, Jodie A. Barkin, MD2, Zsuzasanna Nemeth, MLIS, CCRC3, Jamie S. Barkin, MD, MACG2
1University of Miami, Jackson Memorial Hospital, Miami, FL; 2University of Miami Miller School of Medicine, Miami, FL; 3University of Miami Libraies, Miami, FL
Introduction: Eosinophilic pancreatitis (EP) is a rare form of pancreatitis characterized by diffuse infiltration of the pancreas with eosinophils & elevated serum immunoglobulin E levels. Diagnosis is clinically difficult as endoscopic/radiographic findings often mimic neoplasm, leading to surgical resection. The aim of this review is to chronicle all cases of EP, describe clinical & radiographic presentation & outcome.
Methods: A systematic search was performed with an experienced librarian of PubMed, Embase & Scopus for search terms of “Eosinophilic Pancreatitis” from 1975-4/19/2019. We included all case reports, series, cohorts & randomized studies with diagnosis of EP. Exclusion criteria were articles with other attributable pancreatitis etiology, fetal EP cases, or non-English language. All articles were reviewed by 2 authors. Data was collected on clinical & radiographic findings, comorbidities & outcome.
Results: The search yielded 1379 results of which 18 case reports/series of 23 total patients were included. 17/23 (73.9%) were men, mean age 43.6±17.0 years (range 14-74). Most common symptoms at presentation were abdominal pain (18/23), jaundice (9/23), weight loss (6/23), nausea/vomiting (6/23), & recurrent acute pancreatitis (2/23). Comorbidities included Diabetes Mellitus (2/23) & asthma/allergies (4/23). Imaging revealed abnormalities (mass, hypodensity, or enlargement) located in the pancreatic head (13/23), body (2/23) & tail (3/23). A pancreatic mass was most commonly found (11/23), followed by pancreatic enlargement (8/23), pancreatic duct dilatation (5/23) & bile duct dilatation (8/23). 4/23 patients had a pseudocyst; none had necrosis. Pathology showed prominent eosinophilic infiltrate in all cases, with 5/23 having few lymphocytes & 9/23 with diffuse inflammatory infiltrates. 16/23 patients underwent surgical resection with EP diagnosis made post-operatively. 5/23 patients had complications (4/23 resolved with steroids; 1 died from systemic hypereosinophilia with renal failure & chylothorax).
Discussion: EP presents more commonly in men in a 3:1 ratio in the 5th decade. EP should be considered in patients with abdominal pain, jaundice, & weight loss with imaging of a pancreatic mass or enlargement, or ductal dilation. EP masquerades as malignancy; however, diagnostic clues to EP include peripheral eosinophilia & presence of diabetes or asthma/allergies. Awareness of EP may allow for potential non-operative diagnosis, avoidance of surgery, & appropriate medical therapy.
Citation: Gabriela Kuftinec, MD, MPH; Jodie A. Barkin, MD; Zsuzasanna Nemeth, MLIS, CCRC; Jamie S. Barkin, MD, MACG. P0912 - EOSINOPHILIC PANCREATITIS AS A BENIGN MIMICKER OF PANCREATIC NEOPLASM: A SYSTEMATIC REVIEW. Program No. P0912. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.