Endoscopy and endoscopic ultrasonography for heterotopic pancreas in upper gastrointestinal tract / 中华消化内镜杂志

ABSTRACT

Objective To study the characteristics of heterotopic pancreas (HP) in upper gastrointestinal tract (UGIT) under endoscopy and endoscopic sonography ( EUS), and its endoscopic managements. Methods Data of 67 patients with pathologically confirmed HP in our hospital from March 2004 to November 2009, including clinical and endoscopic manifestations and sequelae after endoscopic resection,were retrospectively studied. Results Heterotopic pancreas were most commonly found as a single lesion in gastric antrum (62/67, 92. 5% ) and in gastric angle and duodenum as well, which were characterized by protrusion, with intact mucous membrane and centrally umbilicated. Of the 67 patients, 59 underwent EUS before endoscopic resection. Findings were heterogeneous and mixed echogenic lesions with indistinct borders involving both the second and third layers of the gastrointestinal wall, sometimes even involving the first and fourth layers. Most lesions (n =60) were removed by endoscopic mucosal resection (EMR), with basal residues in 25 cases, in which fourth layer involvement was observed in 23 cases (92. 0% ). Delayed bleeding occurred in 1 case at 3rd day after the procedure, and no other complications were observed. Complete removal was achieved in 8 cases ( including one receiving EMR previously ) with endoscopic submucosal dissection (ESD) , and there was no such severe complications as perforation. Postoperative pathological examinations revealed that the consistent rate of preoperative diagnosis with EUS was 91.5% (54/59). Conclusion Endoscopy combined with EUS is critical in diagnosis of HP in UGIT. EMR, especially with cap assistance, is the best method for those without involvement of muscularis propria, while ESD or endoscopic surveillance is a better alternative for those with 4th layer involvement.