Ligation-assisted endoscopic mucosal resection of gastric heterotopic pancreas

Abstract

Heterotopic pancreas is a congenital anomaly characterized by ectopic pancreatic tissue. Treatment of heterotopic pancreas may include expectant observation, endoscopic resection or surgery. The aim of this report was to describe the technique of ligation-assisted endoscopic mucosal resection (EMR) for resection of heterotopic pancreas of the stomach. Two patients (both female, mean age 32 years) were referred for management of gastric subepithelial tumors. Endoscopic ultrasound in both disclosed small hypoechoic masses in the mucosa and submucosa. Band ligation-assisted EMR was performed in both cases without complications. Pathology from the resected tumors revealed heterotopic pancreas arising from the submucosa. Margins were free of pancreatic tissue. Ligation-assisted EMR is technically feasible and may be considered for the endoscopic management of heterotopic pancreas.

Figure 1

Endoscopic view of heterotopic pancreas of the stomach showing a medium-sized subepithelial nodule with central umbilication and normal overlying mucosa. The pylorus is visible distally.

Figure 2

Radial EUS images. A pancreatic rest showing an 8 mm × 6 mm hypoechoic subepithelial mass appearing to involve the mucosa (A) and submucosa (B). The tumor was confirmed as submucosal in origin after resection without involvement of the mucosa.

Figure 3

Ligation-assisted EMR of pancreatic rest. The banding device was positioned over the target lesion (A), suction was applied and a band was deployed. The lesion was then resected using electrocautery snare. Residual ulcer is shown (B).

Figure 4

Photomicrograph of the resection specimen showing pancreatic tissue within the gastric submucosa (HE, × 10).

Figure 5

Endoscopic view of heterotopic pancreas of the stomach showing a medium-sized subepithelial nodule with central umbilication and normal overlying mucosa. The pylorus is visible distally.

Figure 6

Radial EUS images of a pancreatic rest showing a 9 mm × 7 mm hypoechoic subepithelial mass appearing to involve the deep mucosa and submucosa. The tumor was confirmed as submucosal in origin after resection without involvement of the mucosa.

Figure 7

Ligation-assisted EMR of pancreatic rest.