Endoscopic removal of gastric ectopic pancreas: an initial experience with endoscopic submucosal dissection

Abstract

Aim: To evaluate the therapeutic usefulness and safety of endoscopic resection in patients with gastric ectopic pancreas.

Methods: A total of eight patients with ectopic pancreas were included. All of them underwent endoscopic ultrasonography before endoscopic resection. Endoscopic resection was performed by two methods: endoscopic mucosal resection (EMR) by the injection-and-cut technique or endoscopic mucosal dissection (ESD).

Results: We planned to perform EMR in all eight cases but EMR was successful in only four cases. In the other four cases, saline spread into surrounding normal tissues and the lesions became flattened, which made it impossible to remove them by EMR. In those four cases, we performed ESD and removed the lesions without any complications.

Conclusion: If conventional EMR is difficult to remove gastric ectopic pancreas, ESD is a feasible alternative method for successful removal.

Figure 1

Endoscopic mucosal resection of ectopic pancreas by injection-and-cut technique (case 3). A: A subepithelial lesion is observed on the greater curvature of the antrum; B: Endoscopic ultrasonography image obtained with a 20 MHz catheter probe. An indistinct, heterogeneous, and hypoechoic lesion with a small anechoic space is located within the submucosal layer; C: Saline with indigo carmine is injected into the submucosa beneath the lesion; D: The lesion is resected using an electrocautery snare; E: The lesion is completely removed; F: The inner surface of the resected specimen; G: Histologically, the ectopic pancreas is located in the submucosa (HE, × 40).

Figure 2

Endoscopic submucosal dissection of ectopic pancreas (case 7). A: A subepithelial lesion with a tiny erosion due to a previous biopsy is observed on the greater curvature of the antrum; B: Endoscopic ultrasonography image obtained with a 20 MHz catheter probe. An indistinct, heterogeneous, and hypoechoic lesion with small anechoic spaces is located within the deep mucosal and submucosal layer; C: By using a standard needle knife, a mark is made on the margin of the lesion; D: Saline injection with epinephrine and indigo carmine is injected into the submucosa beneath the lesion, and then a complete circumference incision is made using an IT knife; E: The IT knife is used to dissect the submucosa; F: The lesion is completely removed; G: The inner surface of the resected specimen; H: Histologically, the ectopic pancreas tissue is located in the deep mucosa and submucosa (HE, × 40).