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Zhang X, Peng L, Wang Z, Pan F, Ren R, Li Y, Zhang X. Extensive heterotopic pancreas in a rare site: A case report and a review of literature. Medicine (Baltimore) 2023; 102:e32241. [PMID: 36862885 PMCID: PMC9981405 DOI: 10.1097/md.0000000000032241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
RATIONALE Heterotopic pancreas is a pancreatic tissue that occurs outside the normal anatomical site, the most common site is antrum. Due to the lack of specific imaging and endoscopic signs, heterotopic pancreas especially those occurring in the rare site, are often misdiagnosed, and leading to unnecessary surgical treatment. Endoscopic incisional biopsy and endoscopic ultrasound-guided fine-needle aspiration are effective means for diagnosing heterotopic pancreas. We reports a case of extensive heterotopic pancreas in a rare site, which was finally diagnosed by this way. PATIENT CONCERNS A 62-year-old man was admitted due to the presence of an angular notch lesion, which was suspected as gastric cancer before. He denied any history of tumor or gastric disease. DIAGNOSES No abnormality was found in the physical examination and laboratory testing after admission. Computed tomography showed localized thickening of the gastric wall measuring 30 mm in the long diameter. Gastroscope revealed a nodular-like submucosal protuberance at the angular notch with size of about 3*4 cm. Ultrasonic gastroscope showed that the lesion was located in the submucosa. The lesion exhibited mixed echogenicity. The diagnosis can not be identified. INTERVENTIONS 2 times of incision biopsy were performed to make a clear diagnosis. Finally, appropriate tissue specimens were obtained for pathology testing. OUTCOMES The patient was diagnosed as heterotopic pancreas according to pathology. He was recommended to undergo observation and regular follow-ups rather than surgery. Then he was discharged home with no discomfort. LESSONS Heterotopic pancreas occurring in the angular notch is extremely rare, the site is scarcely reported in the relevant literature. Therefore, it is easy to be misdiagnosed. In the cases of an vague diagnosis, endoscopic incisional biopsy or endoscopic ultrasound-guided fine-needle aspiration may be a good choice.
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Affiliation(s)
- Xiaohan Zhang
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- School of Medicine, Nankai University, Tianjin, China
| | - Lihua Peng
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Zikai Wang
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Fei Pan
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Rongrong Ren
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yan Li
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xiuli Zhang
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- * Correspondence: Xiuli Zhang, Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing 100853, China (e-mail: )
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Braga M, Matos AP, Marques PP, Ramalho M. Gastric ectopic pancreas in magnetic resonance imaging: A review of 2 cases. Radiol Case Rep 2023; 18:1181-1185. [PMID: 36660566 PMCID: PMC9842967 DOI: 10.1016/j.radcr.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 12/04/2022] [Indexed: 01/13/2023] Open
Abstract
Gastric ectopic pancreas (EP) is an uncommon congenital anomaly in which pancreatic tissue with no anatomic connection to the main pancreas is found in the stomach. Gastric EP is often discovered incidentally when a nonspecific submucosal tumor is found in endoscopic studies or other imaging examinations. Tissue characterization by biopsy or fine-needle aspiration is required as endoscopic findings alone cannot exclude malignancy. The authors present 2 cases of gastric EP incidentally detected on endoscopy, which underwent further characterization by magnetic resonance imaging (MRI). In both cases, MRI showed submucosal gastric lesions, isointense to the orthotopic pancreas in all sequences, including hyperintensity on T1-weighted images. Furthermore, the lesions showed bright arterial phase enhancement, paralleling the native pancreas. MRI may provide the best non-invasive imaging method for evaluating gastric submucosal lesions. This report intends to show that EP shows a characteristic MR appearance that allows differentiation from other submucosal lesions.
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Affiliation(s)
- Miguel Braga
- Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, R. Prof. Lima Basto, 1099-023, Lisbon, Portugal
- Corresponding author.
| | - António P. Matos
- Department of Radiology, Hospital CUF Tejo, Av. 24 de Julho 171A, 1350-352, Lisbon, Portugal
| | - Pedro Pinto Marques
- Department of Gastroenterology, Hospital Garcia de Orta E.P.E., Av. Torrado da Silva, 2805-267, Almada, Portugal
| | - Miguel Ramalho
- Department of Radiology, Hospital Garcia de Orta E.P.E., Av. Torrado da Silva, 2805-267, Almada, Portugal
- Department of Radiology, Hospital da Luz, Av. Lusíada 100, 1500-650 Lisbon, Portugal
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ACG Clinical Guideline: Diagnosis and Management of Gastrointestinal Subepithelial Lesions. Am J Gastroenterol 2023; 118:46-58. [PMID: 36602835 DOI: 10.14309/ajg.0000000000002100] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/29/2022] [Indexed: 01/06/2023]
Abstract
Subepithelial lesions (SEL) of the GI tract represent a mix of benign and potentially malignant entities including tumors, cysts, or extraluminal structures causing extrinsic compression of the gastrointestinal wall. SEL can occur anywhere along the GI tract and are frequently incidental findings encountered during endoscopy or cross-sectional imaging. This clinical guideline of the American College of Gastroenterology was developed using the Grading of Recommendations Assessment, Development, and Evaluation process and is intended to suggest preferable approaches to a typical patient with a SEL based on the currently available published literature. Among the recommendations, we suggest endoscopic ultrasound (EUS) with tissue acquisition to improve diagnostic accuracy in the identification of solid nonlipomatous SEL and EUS fine-needle biopsy alone or EUS fine-needle aspiration with rapid on-site evaluation sampling of solid SEL. There is insufficient evidence to recommend surveillance vs resection of gastric gastrointestinal stromal tumors (GIST) <2 cm in size. Owing to their malignant potential, we suggest resection of gastric GIST >2 cm and all nongastric GIST. When exercising clinical judgment, particularly when statements are conditional suggestions and/or treatments pose significant risks, health-care providers should incorporate this guideline with patient-specific preferences, medical comorbidities, and overall health status to arrive at a patient-centered approach.
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Paramythiotis D, Kollatou AS, Simou T, Karlafti E, Abba Deka I, Petrakis G, Didangelos T, Michalopoulos A. Ectopic pancreatic tissue in stomach: A case report. Ann Med Surg (Lond) 2022; 79:104005. [PMID: 35860114 PMCID: PMC9289346 DOI: 10.1016/j.amsu.2022.104005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/11/2022] [Accepted: 06/12/2022] [Indexed: 02/07/2023] Open
Abstract
Introduction and importance Ectopic Pancreas (EP) is a rare condition that is mostly found in the Gastrointestinal tract and especially in the stomach. Although the lesion is mainly asymptomatic, non-specific symptoms can be present, making the diagnosis even more challenging. Case presentation In our case a 52-year-old woman, with heartburn as the only symptom, was undergone successive examinations, indicating a subepithelial lesion in the antrum of the stomach, from which only Magnetic Resonance Imaging (MRI) indicated the presence of ectopic pancreas, while Computed Tomography results considered the mass as Gastrointestinal Stromal Tumor. Wedge gastrectomy was performed in order to extract the lesion and the histopathological examination confirmed the findings of the MRI. The patient fully recovered with no complications. Clinical discussion In most cases, EP is described in endoscopy as a subepithelial mass with normal mucosa. As EP can mimic other subepithelial masses, even adenocarcinoma, it is of utmost importance not to omit the performance of surgical removal and histopathological examination. Consequently, resection is essential not only for the diagnosis but also for the treatment of the patient. Conclusion EP is not a usually detected clinical pathology. There is no specific algorithm, which physicians should follow in order to reach the diagnosis without the surgical intervention. For this reason, clinicians should be conscious of the existence of EP in the stomach. Ectopic pancreas (EP) is mostly found in the gastrointestinal tract. EP in stomach first considered as a Gastrointestinal Stromal Tumor (GIST). Resection is essential for the diagnosis and for the treatment of the patient.
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LeCompte MT, Mason B, Robbins KJ, Yano M, Chatterjee D, Fields RC, Strasberg SM, Hawkins WG. Clinical classification of symptomatic heterotopic pancreas of the stomach and duodenum: A case series and systematic literature review. World J Gastroenterol 2022; 28:1455-1478. [PMID: 35582670 PMCID: PMC9048474 DOI: 10.3748/wjg.v28.i14.1455] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/11/2021] [Accepted: 03/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Heterotopic pancreas (HP) is an aberrant anatomic malformation that occurs most commonly in the upper gastrointestinal tract. While the majority of heterotopic pancreatic lesions are asymptomatic, many manifest severe clinical symptoms which require surgical or endoscopic intervention. Understanding of the clinical manifestations and symptoms of HP is limited due to the lack of large volume studies in the literature. The purpose of this study is to review symptomatic cases at a single center and compare these to a systematic review of the literature in order to characterize common clinical manifestations and treatment of this disease.
AIM To classify the common clinical manifestations of heterotopic pancreas.
METHODS A retrospective review was conducted of pathologic samples containing heterotopic pancreas from 2000-2018. Review was limited to HP of the upper gastrointestinal tract due to the frequency of presentation in this location. Symptomatic patients were identified from review of the medical records and clinical symptoms were tabulated. These were compared to a systematic review of the literature utilizing PubMed and Embase searches for papers pertaining to heterotopic pancreas. Publications describing symptomatic presentation of HP were selected for review. Information including demographics, symptoms, presentation and treatment were compiled and analyzed.
RESULTS Twenty-nine patient were identified with HP at a single center, with six of these identified has having clinical symptoms. Clinical manifestations included, gastrointestinal bleeding, gastric ulceration with/without perforation, pancreatitis, and gastric outlet obstruction. Systemic review of the literature yielded 232 publications detailing symptomatic cases with only 20 studies describing ten or more patients. Single and multi-patient studies were combined to form a cohort of 934 symptomatic patients. The majority of patients presented with abdominal pain (67%) combined with one of the following clinical categories: (1) Dyspepsia, (n = 445, 48%); (2) Pancreatitis (n = 260, 28%); (3) Gastrointestinal bleeding (n = 80, 9%); and (4) Gastric outlet obstruction (n = 80, 9%). The majority of cases (n = 832, 90%) underwent surgical or endoscopic resection with 85% reporting resolution or improvement in their symptoms.
CONCLUSION Heterotopic pancreas can cause significant clinical symptoms in the upper gastrointestinal tract. Better understanding and classification of this disease may result in more accurate identification and treatment of this malformation.
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Affiliation(s)
- Michael T LeCompte
- Department of Surgical Oncology, University of North Carolina, Raleigh, NC 27608, United States
| | - Brandon Mason
- Department of Radiology, Stillwater Medical Center, Stillwater, OK 74074, United States
| | - Keenan J Robbins
- Department of General Surgery, Washington University St. Louis, St. Louis, MO 63110-8109, United States
| | - Motoyo Yano
- Department of Radiology, Mayo Clinic, Phoenix, AZ 8505, United States
| | - Deyali Chatterjee
- Department of Pathology and Immunology, MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Ryan C Fields
- Department of Surgical Oncology, Washington University School of Medicine, St. Louis, MO 63110-8109, United States
| | - Steven M Strasberg
- Section of Hepatobiliary-Pancreatic and GI Surgery, Washington University St. Louis, St. Louis, MO 63110, United States
| | - William G Hawkins
- Section of Hepatobiliary-Pancreatic and GI Surgery, Washington University St. Louis, St. Louis, MO 63110, United States
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Yang CW, Che F, Liu XJ, Yin Y, Zhang B, Song B. Insight into gastrointestinal heterotopic pancreas: imaging evaluation and differential diagnosis. Insights Imaging 2021; 12:144. [PMID: 34674040 PMCID: PMC8531187 DOI: 10.1186/s13244-021-01089-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/29/2021] [Indexed: 02/08/2023] Open
Abstract
Heterotopic pancreas (HP) is an uncommon congenital abnormality in the developmental process of the pancreas, with gastrointestinal heterotopic pancreas (GHP) being the most common HP. The clinical manifestations of GHP may have variable patterns of presentation, dictated by both the anatomic location and the functional ability of the lesion. The most common imaging modality in detecting GHP is computed tomography (CT), while gastrointestinal barium fluoroscopy, endoscopic ultrasonography, and magnetic resonance imaging (MRI) are also applied. The density and enhancement patterns of GHP are consistent with histological classifications. GHP with a predominantly acinar tissue component manifests homogeneous and marked enhancement on CT images, whereas a predominantly ductal GHP presents heterogeneous and mild enhancement. On MRI, the appearance and signal intensity of GHP were paralleled to the normal pancreas on all sequences and were characterized by T1-weighted high signal and early marked enhancement. This article provides a comprehensive review of the histopathology, clinical manifestations, imaging features of various modalities, and differential diagnosis of GHP. It is hoped that this review will improve clinicians' knowledge of GHP and aid in accurate preoperative diagnosis, thereby reducing the misdiagnosis rate.
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Affiliation(s)
- Cai-Wei Yang
- West China School of Medicine, Sichuan University, Chengdu, 610041, China
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Feng Che
- West China School of Medicine, Sichuan University, Chengdu, 610041, China
| | - Xi-Jiao Liu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Yuan Yin
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Bo Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
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Lee HS, Kim DH, Park SY, Kim S, Kim GT, Cho E, Yoon JH, Park CH, Kim HS, Choi SK, Kim NI, Rew JS. Endoscopic and Endosonographic Features of Histologically Proven Gastric Ectopic Pancreas by Endoscopic Resection. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2021; 76:9-16. [PMID: 32703915 DOI: 10.4166/kjg.2020.76.1.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/26/2020] [Accepted: 04/27/2020] [Indexed: 12/27/2022]
Abstract
Backgrounds/Aims Distinguishing gastric ectopic pancreas (GEP) from malignant tumors is relatively difficult. This study evaluated the endosonography findings of pathologically proven GEP. Methods Thirty-one patients diagnosed with GEP based on a histopathological analysis from January 2004 to July 2018 were enrolled in this study. All patients underwent EUS and an endoscopic resection. Results Seventeen patients were female, and the median age was 41.1 years (range, 14-74). The lesions were localized most commonly in the antrum. The mean size of the GEP was 10.6 mm (range, 7-15). Superficial type lesions, lesions with heterogeneous echogenicity, mixed pattern lesions, and lesions with indistinct borders were commonly observed on EUS. Calcification, anechoic duct-like structures, and thickening of the muscularis propria were observed in some patients. Endoscopic mucosal resection (41.9%) and endoscopic submucosal dissection (58.1%) were performed. The mean procedure time was 22.5 minutes. Complete resection was achieved for 71% of patients. No statistically significant results between the endosonography findings and complete resection rates were obtained. The mean follow-up esophagogastroduodenoscopy duration was 4.5 months. None of the patients presented with residual lesions on subsequent endoscopy. Conclusions EUS can help identify the features of GEP. Careful observations of the EUS findings can avoid unnecessary removal of GEP.
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Affiliation(s)
- Ho-Sung Lee
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Dong Hyun Kim
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Seon-Young Park
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Sunmin Kim
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Gwang Taek Kim
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Eunae Cho
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Jae Hyun Yoon
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Chang Hwan Park
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Hyun Soo Kim
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Sung Kyu Choi
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Nah Ihm Kim
- Department of Pathology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Jong Sun Rew
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
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Kim DH, Park CH, Park SY, Cho E, Kim HS, Choi SK. Diagnostic yields of endoscopic ultrasound-guided fine-needle tissue acquisition according to the gastric location. Medicine (Baltimore) 2021; 100:e26477. [PMID: 34160458 PMCID: PMC8238348 DOI: 10.1097/md.0000000000026477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/08/2021] [Indexed: 01/04/2023] Open
Abstract
The diagnostic accuracy of endoscopic ultrasound-guided fine-needle tissue acquisition (EUS-FNTA) according to the gastric location of subepithelial tumors (SETs) has not been well established. We aimed to evaluate the efficacy of EUS-FNTA for the diagnosis of gastric SETs according to tumor location.Thirty-three patients diagnosed with gastric SETs via EUS-FNTA from January 2016 to May 2018 were analyzed retrospectively. Patient demographics, diagnostic yields, and complications were evaluated.Nineteen patients (57.6%) were female, with a mean age of 57.7 years. Endoscopic ultrasound revealed a mean longitudinal diameter of 25.6 mm. The most common location of SETs was in the gastric body (n = 18, 54.5%), followed by cardia and fundus (n = 10, 30.3%), and antrum (n = 5, 15.2%). A 20-gauge biopsy needle was most frequently used (90.9%). The diagnostic yield was obtained in 23 patients (69.7%). The most common diagnosis was gastrointestinal stromal tumor (73.9%), followed by leiomyoma (17.4%). The diagnostic yield of SETs in gastric antrum (0/5, 0%) was significantly lower than that in the gastric body and cardia (23/28, 82.1%, P = .001). A case of immediate bleeding after EUS-FNTA occurred in 1 patient (3.0%) who recovered uneventfully. According to related literature, the overall diagnostic yield of SETs in gastric antrum was significantly lower than that in the gastric body, fundus, and cardia (29.7% vs 71.4%, P < .001, n = 191).EUS-FNTA is ineffective in the diagnosis of SETs in the gastric antrum. Although EUS-FNTA is an advanced diagnostic tool for gastric SETs, it is essential to develop more effective methods for the diagnosis of antral SETs.
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Leung G, Mills J, Bucobo JC, Docimo S. Evaluation and management of a pancreatic rest noted during pre-bariatric surgery screening endoscopy. Surg Endosc 2020; 35:536-561. [PMID: 33006030 DOI: 10.1007/s00464-020-08040-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/22/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Pancreatic rest (PR) is an ectopic pancreatic lesion that is usually found incidentally on endoscopy or surgery. While most lesions do not have clinical significance, some patients are symptomatic and rarely, PR can predispose to malignancy. With the growing popularity of bariatric surgery, it has been unclear how to manage PR found on screening endoscopies, prior to bariatric surgery. Through review of the current literature, we propose an algorithm for clinicians to evaluate and manage PR found on screening endoscopies prior to bariatric surgery. METHODS We performed a literature search in PubMed pertaining to PR, clinical characteristics, risk of malignant transformation, endoscopic characteristics, histological descriptions, and resection techniques. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), we found 33 published articles from 2001 to 2019, including case reports, case series, retrospective cohorts, and a review paper. RESULTS PR is commonly found incidentally in the gastric antrum. Larger lesions have a higher risk of being symptomatic or predisposing to malignant transformation. Endoscopic ultrasound (EUS) can assist in the diagnosis of PR and guide resection technique. Certain histological characteristics, such as Heinrich class, grading of neoplasia, and genetic alterations, can determine malignancy risk of PR. Resection technique, either endoscopically or surgically, should be based on lesion size, depth of wall invasion, and the endoscopists' level of skill in endoscopic resection. CONCLUSIONS Proper evaluation and treatment of PR should be considered because of the risk for symptoms and malignant transformation. Symptomatic lesions and those at risk for malignant transformation should be considered for resection. EUS can guide the diagnosis and type of resection, either endoscopically through EMR or ESD or surgically through sleeve gastrectomy or Roux-en-Y gastric bypass (RYGB).
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Affiliation(s)
- Galen Leung
- Department of Medicine, Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY, 11794, USA.
| | - John Mills
- Department of Surgery, University of Pittsburgh Medical Center Pinnacle, 4300 Londonderry Road, Harrisburg, PA, 17109, USA
| | - Juan Carlos Bucobo
- Department of Medicine, Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY, 11794, USA
| | - Salvatore Docimo
- Department of Surgery, Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY, 11794, USA
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Hu J, Liu W, Chen Z, Lin D, Su M, Lan P. A Novel Snare Traction-Assisted Method During Endoscopic Resection for Upper Gastrointestinal Submucosal Tumors. J Laparoendosc Adv Surg Tech A 2020; 31:416-422. [PMID: 32924769 DOI: 10.1089/lap.2020.0462] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Traction-assisted endoscopic resection is an approach to provide better procedural outcomes than conventional endoscopic procedure in treating gastric or esophageal epithelial lesions. Submucosal tumors (SMTs) are challenging to resect endoscopically due to the difficulty in exposure and high incidence of full-thickness resection. In this study, we investigated the efficacy of snare traction-assisted method, served as an "extra hand," for upper gastrointestinal SMTs. Methods: From June 2019 to May 2020, we used the snare traction-assisted method to treat 11 patients with 12 upper gastrointestinal SMTs in the Sixth Affiliated Hospital, Sun Yat-sen University. The duration of the procedures and the outcomes were recorded. Results: A total of 11 patients with 12 lesions were treated by snare traction-assisted endoscopic resection. The mean procedure time was 26.8 ± 8.3 minutes. En bloc resection was achieved in all the 12 lesions. The mean length of the specimens was 11.5 ± 4.0 mm. Full-thickness resection was performed in four lesions. The patients were discharged in 5.0 days after procedures without delayed bleeding or other complication reported. Conclusion: Snare traction-assisted method is an effective tool for endoscopic resection of upper gastrointestinal SMTs. Further prospective studies comparing the snare traction-assisted method with the conventional procedure are necessary.
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Affiliation(s)
- Jiancong Hu
- Department of Endoscopic Surgery, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Wei Liu
- Department of Endoscopic Surgery, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zexian Chen
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Dezheng Lin
- Department of Endoscopic Surgery, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Mingli Su
- Department of Endoscopic Surgery, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ping Lan
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
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Alqahtani A, Aljohani E, Almadi F, Billa S, Alqahtani M, Alkhaldi H. Heterotopic pancreatic tissue in the gastric antrum an incidental finding during bariatric surgery: A case report and literature review. Int J Surg Case Rep 2020; 67:39-41. [PMID: 32004902 PMCID: PMC7076269 DOI: 10.1016/j.ijscr.2019.12.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/13/2019] [Accepted: 12/20/2019] [Indexed: 11/29/2022] Open
Abstract
Heterotopic pancreas, is presence of pancreatic tissue outside its normal location without anatomic continuity with the main body of the pancreas. The Heterotopic pancreas can be in the stomach, duodenum, jejunum, or a Meckel diverticulum. This is the first reported case of gastric heterotopic pancreas found during a bariatric surgery procedure.
Introduction Heterotopic pancreas, also known as ectopic pancreas, is defined as the presence of pancreatic tissue outside its normal location and without anatomic and vascular continuity with the main body of the pancreas. The incidence of heterotopic pancreas has been reported as 0.5 % during laparotomies and at autopsy ranging from 0.6–14 %. Presentation of case A 28 years old obese male, medically free electively admitted for laparoscopic sleeve gastrectomy. Intraoperatively after dissecting the greater omentum from the stomach and inserting the 36 Fr gastric bougie, small oval shape mass about 1 cm close to the lesser curvature on the anterior surface of the gastric antrum. Macroscopically benign looking and a thorough laparoscopic exploration showed no signs of other organs involvement. Antrectomy and mini gastric bypass done. The postoperative course was uneventful. The histopathological examination of the antrectomy specimen showed heterotopic pancreas in the subserosa of gastric antrum. Discussion The Heterotopic pancreatic tissue can be discovered in the stomach (particularly antrum), duodenum, jejunum, or a Meckel diverticulum. Surgical resection is the mainstay treatment if the heterotopic pancreas is symptomatic or when the lesion is found incidentally during surgery in order to prevent complications. Conclusion Heterotopic pancreas should always be considered in the differential diagnosis of incidentally found gastric lesions and can be safely resected. This is the first case report of gastric heterotopic pancreas which is found incidentally during a bariatric surgery procedure.
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Affiliation(s)
| | - Emad Aljohani
- Department of Surgery, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-kharj, Saudi Arabia
| | - Fahad Almadi
- King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Srikar Billa
- Dr.Suliman Alhabib Hospital, Riyadh, Saudi Arabia
| | | | - Hisham Alkhaldi
- Histopathology Department, Dr.Suliman Alhabib Hospital, Riyadh, Saudi Arabia
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Gottschalk U, Dietrich CF, Jenssen C. Ectopic pancreas in the upper gastrointestinal tract: Is endosonographic diagnosis reliable? Data from the German Endoscopic Ultrasound Registry and review of the literature. Endosc Ultrasound 2018; 7:270-278. [PMID: 28836514 PMCID: PMC6106155 DOI: 10.4103/eus.eus_18_17] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Ectopic pancreas (EP) belongs to the most frequent subepithelial lesions (SELs) of the upper gastrointestinal (GI) tract. In the majority of cases, it is detected incidentally. Differential diagnosis from mesenchymal subepithelial tumors may be difficult. Methods: Among 24,308 endosonographic examinations and interventions, which were prospectively enrolled in the database of the German Endoscopic Ultrasound (EUS) Registry from January 2009 to August 2013, 575 were performed for suspected SELs of the upper GI tract. Sixty three cases of EP of the upper GI tract (stomach, n = 53; duodenum, n = 10; esophagus, n = 0) were extracted and retrospectively reviewed. Results: In 65.1% of cases, radial echoendoscopes or radial miniprobes were used for examination. Nearly 84% of EP was found in the stomach, 16% in the duodenum, none in the esophagus. In 88.9% of cases, the EUS examination discerned the layer of origin. In 59% of cases EP was described as a heterogeneous, in 28.6% as a homogeneous-hypoechoic and in 7.9% as a homogeneous-echogenic subepithelial mass lesion. Mean diameter was 13.0 mm × 8.1 mm, the mean ratio between long and short axis diameter was 1.75. EUS-guided fine needle aspiration (EUS-FNA) was used to accomplish cytological or histological diagnosis in only 6.3% of cases. Conclusions: EP accounts for 11% of all EUS examinations performed for subepithelial lesions of the upper GI tract and prospectively enrolled in the German EUS registry. Rather than being an eyecatcher, EP is a chameleon with numerous differential diagnoses. In selected cases, EUS-FNA may help clarifying the diagnosis.
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Affiliation(s)
- Uwe Gottschalk
- Medical Department, Dietrich-Bonhoeffer-Klinikum, Neubrandenburg, Germany
| | - Christoph F Dietrich
- Medical Department, Caritas Krankenhaus, Uhlandstr 7, D-97980, Bad Mergentheim, Germany
| | - Christian Jenssen
- Medical Department, Krankenhaus Märkisch Oderland, Strausberg/Wriezen, Germany
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Yoon JB, Lee BE, Kim DH, Park DY, Jeon HK, Baek DH, Kim GH, Song GA. A Rare Case of Early Gastric Cancer Combined with Underlying Heterotopic Pancreas. Clin Endosc 2017; 51:192-195. [PMID: 28854774 PMCID: PMC5903075 DOI: 10.5946/ce.2017.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 07/15/2017] [Accepted: 08/16/2017] [Indexed: 12/27/2022] Open
Abstract
Heterotopic pancreas in the stomach is usually asymptomatic and benign. Here, we presented a rare case of an early gastric cancer overlying a heterotopic pancreas. A 48-year-old woman underwent esophagogastroduodenoscopy, which revealed a subepithelial mass measuring 2.0×1.5 cm on the gastric antrum with a 1-cm erosive erythematous discoloration on the surface. A biopsy specimen showed moderately differentiated tubular adenocarcinoma. Endosonography showed a heterogeneous hypoechoic mass measuring 1.3×0.6 cm, with indistinct margins in the second and third layers of the gastric wall; anechoic tubular structures within the mass were suggestive of heterotopic pancreas. Distal gastrectomy was performed, which confirmed an early gastric cancer confined to the mucosa, and a separate underlying heterotopic pancreas. Although heterotopic pancreas is most likely benign, careful endoscopic observation of the mucosal surface is necessary to avoid overlooking a coincident early gastric cancer.
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Affiliation(s)
- Jung Bin Yoon
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Bong Eun Lee
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Dae Hwan Kim
- Department of Surgery, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Do Youn Park
- Department of Pathology, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hye Kyung Jeon
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Dong Hoon Baek
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Geun Am Song
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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Ectopic pancreas in the stomach successfully resected by endoscopic submucosal dissection. Case Rep Med 2015; 2015:147927. [PMID: 25878668 PMCID: PMC4387910 DOI: 10.1155/2015/147927] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 03/18/2015] [Indexed: 12/18/2022] Open
Abstract
A 32-year-old Japanese man presented with a gastric submucosal tumor. Esophagogastroduodenoscopy showed a sessile submucosal tumor measuring approximately 10 mm in diameter on the greater curvature of the gastric antrum. Endoscopic ultrasonography examination revealed a solid tumor with a diameter of 11.8 mm, which was located in the deep mucosal and submucosal layers. The internal echogenicity was homogenous and hypoechoic. Biopsy examinations were performed twice but were not diagnostic since only the intact mucosal layer was obtained. The patient was subsequently diagnosed with ectopic pancreas in the stomach by endoscopic submucosal dissection (ESD). This case underscores the usefulness of the ESD technique for the pathological diagnosis of gastric submucosal tumors.
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