Cystic dystrophy of the duodenal wall associated with chronic alcoholic pancreatitis. Clinical features, diagnostic procedures and therapeutic management in a retrospective multicenter series of 23 patients.
OBJECTIVE
The aim of this retrospective multicenter study was to collect data from patients with chronic alcoholic pancreatitis and cystic dystrophy of the duodenal wall in order to better understand the outcome after medical, endoscopic and/or surgical treatment.


METHODS
The data from medical records of 23 patients consecutively seen in ten primary referral centers from January 1990 to July 2004 were studied. Clinical, biological, and endoscopic features as well as imaging findings were recorded. Response to treatment was noted.


RESULTS
Twenty-three patients (20 men), aged 45 years (range: 30-66), with chronic alcohol intake, cystic dystrophy of the duodenal wall, and previously known (N=14) or simultaneously diagnosed (N=9) chronic pancreatitis were included. Symptoms most frequently encountered were abdominal pain (N=22) and weight loss (N=16). An abdominal ultrasound was available for 10 patients, abdominal computed tomography for 22, upper endoscopy for 18, and endoscopic ultrasonography for 22. Endoscopic ultrasonography enabled diagnosis of cystic dystrophy of the duodenal wall in 19/22 patients. Six patients were symptom-free after alcohol withdrawal. Seven patients received octreotide 200 to 400 microg per day, 5 of whom subsequently underwent surgery (71%). Fourteen patients out of 23 were operated on (61%), 11 of whom underwent pancreaticoduodenectomy and remained symptom-free for 47 months follow-up. Mean follow-up was 56 months (range: 2-78) for non surgical patients (39%) and 47 months (range: 12-108) for surgical patients (61%).


CONCLUSIONS
Cystic dystrophy of the duodenal wall complicating chronic alcoholic pancreatitis may be the revealing sign of pancreatitis. Endoscopic ultrasongraphy is the most reliable imaging method for diagnosis. Pancreaticoduodenectomy is the most frequently employed definitive treatment.
Jouannaud
Vincent
V
Services d'Hépato-Gastroentérologie des Centres Hospitaliers Généraux de Creil.
Coutarel
Pierre
P
Tossou
Hervé
H
Butel
Joël
J
Vitte
René-Louis
RL
Skinazi
Florence
F
Blazquez
Martine
M
Hagège
Hervé
H
Bories
Christian
C
Rocher
Philippe
P
Belloula
Djamel
D
Latrive
Jean-Paul
JP
Meurisse
Jean-Jacques
JJ
Eugène
Claude
C
Dellion
Marie-Pierre
MP
Cadranel
Jean-François
JF
Pariente
Alex
A
D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000368:Aged; D003560:Cysts / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D004378:Duodenal Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D004386:Duodenum / Q000473:pathology*; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D019512:Pancreatitis, Alcoholic / Q000150:complications*; D012189:Retrospective Studies; D015431:Weight Loss