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.