Endoscopic submucosal dissection of gastric ectopic pancreas.

Abstract

Patients with gastric tumors usually present with symptoms of discomfort or pain in the epigastrium, regurgitations, nausea, vomiting or melena. Treatment options include open and laparoscopic total or partial gastrectomy and recently endoscopic mucosal resection. A case of successful endoscopic submucosal dissection is described with the unusual pathological finding of heterotopic pancreatic tissue forming a gastric tumor. The 67-year-old male patient was operated on due to the initial diagnosis of gastro-intestinal stromal tumor of the gastric trunk. Two intra-operative biopsies were negative for cancer cells. Submucosal endoscopic dissection was performed with IT and Hook knives (Olympus). A literature review was performed. The operative time was 180 min with hospital stay of 6 days. During the injection of the carmine dye and the air insufflation pneumoperitoneum occurred and remained clinically silent during the observation period. The pathology result showed a heterotopic pancreatic tissue type 2 according to Heinrich's classification with microfoci of intestinal metaplasia. Preoperative diagnostics of gastric masses might be misleading and such tumors not necessarily should be excised. There are several surgical options with endoscopic submucosal dissection being probably the safest one and a non-disabling approach. Patients tolerate that kind of surgery well with good postoperative functional outcomes.

Endoscopic submucosal dissection for gastric ectopic pancreas: a single-center experience

“…Clinical symptoms of EP are not typical, and the abdominal pain is commonly found [1, 5, 10]. However, the factor causing abdominal pain remains unknown.…”

“…Ectopic pancreas could occur anywhere in the gastrointestinal tract, but the most common site is stomach [4]. Gastric ectopic pancreas is defined as the pancreatic tissue located in the stomach which does not continue to the pancreas and has independent innervation and vascular supply [5]. Upper abdomen pain or discomfort, acid reflux, nausea, and vomiting are the common symptoms of gastric ectopic pancreas while these symptoms are not specific.…”

“…The major conventional treatment is surgery or laparoscopic [6]. ESD is a minimally invasive approach for the treatment of digestive disease and has been widely applied [5]. ESD could allow “en bloc” and complete resection for superficial gastric tumors.…”

“…And it could provide the pathological assessment preciously. However, previous studies reporting the safety and feasibility of ESD for EP were based on limited data [5, 7]. Therefore, the purpose of this study is to report 93 patients with EP treated with ESD in a single Chinese center.…”

Gastric heterotopic pancreas masquerading as a stromal tumor: A case report

“…However, patients with symptoms do require further therapy. Three methods of treatment intervention currently exist: Classic laparotomy with wedge resection, laparoscopic sleeve resection and endoscopic submucosal dissection (33)(34)(35), the latter of which has been gaining in popularity over the last decade. Traditional surgical interventions may be preferred in less experienced centers due to the incorrect identification of ectopic pancreases, leading to unnecessary partial or total gastrectomies in certain patients.…”