%0 Journal Article
%T Increased Incidence of Benign Pancreatic Pathology following Pancreaticoduodenectomy for Presumed Malignancy over 10 Years despite Increased Use of Endoscopic Ultrasound
%A Shadi S. Yarandi
%A Thomas Runge
%A Lei Wang
%A Zhijian Liu
%A Yueping Jiang
%A Saurabh Chawla
%A Kevin E. Woods
%A Steven Keilin
%A Field F. Willingham
%A Hong Xu
%A Qiang Cai
%J Diagnostic and Therapeutic Endoscopy
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/701535
%X Despite using imaging studies, tissue sampling, and serologic tests about 5每10% of surgeries done for presumed pancreatic malignancies will have benign findings on final pathology. Endoscopic ultrasound (EUS) is used with increasing frequency to study pancreatic masses. The aim of this study is to examine the effect of EUS on prevalence of benign diseases undergoing Whipple over the last decade. Patients who underwent Whipple procedure for presumed malignancy at Emory University Hospital from 1998 to 2011 were selected. Demographic data, history of smoking and drinking, history of diabetes and pancreatitis, imaging data, pathology reports, and tumor markers were extracted. 878 patients were found. 95 (10.82%) patients had benign disease. Prevalence of benign finding had increased over the recent years despite using more EUS. Logistic regression models showed that abdominal pain (OR: 5.829, 95% CI 2.681每12.674, ≒ 0.001) and alcohol abuse (OR: 3.221, CI 95%: 1.362每7.261, : 0.002) were predictors of benign diseases. Jaundice (OR: 0.221, 95% CI: 0.084每0.58, : 0.002), mass (OR: 0.145, 95% CI: 0.043每0.485, : 0.008), and ductal dilation (OR: 0.297, 95% CI 0.134每0.657, : 0.003) were associated with malignancy. Use of imaging studies, ERCP, and EUS has not decreased the percentage of benign findings after surgery for presumed pancreatic malignancy. 1. Introduction Pancreatic cancer accounts for 2% of newly diagnosed malignancies, with pancreaticoduodenectomy (The Whipple procedure) being the only potentially curative treatment [1]. Differentiating between pancreatic carcinoma and benign diseases of the pancreas such as chronic pancreatitis is challenging. Pancreatic cancer can present with vague symptoms that overlap with the symptomatology of benign diseases and have an insidious course. The imaging findings also overlap between benign and malignant diseases and no single finding such as pancreatic duct dilation, focal mass, cyst, or abnormal enhancement pattern can reliably make the differentiation. In addition, secondary inflammatory changes are often seen in pancreatic cancer while chronic pancreatitis is associated with an increased risk of pancreatic carcinoma [2]. Although the outcome of the Whipple procedure has improved significantly over the past years and is associated with 1-2% mortality when performed in large volume centers, the morbidity of the procedure remains high [3]. Therefore, constant efforts are being made to improve available diagnostic tools in order to prevent performing Whipple for benign diseases. Despite the advances in imaging
%U http://www.hindawi.com/journals/dte/2014/701535/