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. 2014:2014:160601.
doi: 10.1155/2014/160601. Epub 2014 Oct 12.

Endosonographic features of histologically proven gastric ectopic pancreas

Jen-Wei Chou  1 , Ken-Sheng Cheng  1 , Chun-Fu Ting  2 , Chun-Lung Feng  2 , Yu-Ta Lin  2 , Wen-Hsin Huang  1
Affiliations

Endosonographic features of histologically proven gastric ectopic pancreas

Jen-Wei Chou et al. Gastroenterol Res Pract. 2014.

Abstract

Gastric ectopic pancreas is an uncommon developmental anomaly and its histological diagnosis is usually difficult by using a conventional biopsy forceps. In the literature, most cases of gastric ectopic pancreas were usually diagnosed by gross pattern during endoscopic examination or features of endoscopic ultrasound. In contrast, this disease was seldom diagnosed by histology in clinical practice. Although the typical endoscopic ultrasonographic features of ectopic pancreas include heterogeneous echogenicity, indistinct borders, and a location within 2 or more layers, it can also exhibit hypoechoic homogeneous echogenicity and a distinct border within the fourth sonographic layer (muscularis propria) similar to the endoscopic ultrasonographic features of gastrointestinal stromal tumors. In our study, we found that 53% of gastric ectopic pancreas originated within the fourth sonographic layer, demonstrating hypoechoic, homogeneous echogenicity, and distinct borders. Therefore, recognizing endoscopic ultrasonographic features, combining with deep biopsy, endoscopic ultrasound-guided fine needle aspiration/core needle biopsy can prevent conducting unnecessary resection. Surgical resection is the mainstay treatment for symptomatic gastric ectopic pancreas, but endoscopic resection using endoscopic mucosal resection or endoscopic submucosal dissection technique provides an alternative method of removing superficial-type and deep-type gastric ectopic pancreas.

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Figures

Figure 1
Figure 1
Ectopic pancreas originates from the second and third sonographic layers of the gastric wall. (a) A subepithelial tumor with intact but uneven surface was identified in the antrum. (b) Endoscopic ultrasonographic image obtained with a 12 MHz catheter probe. The tumor exhibits heterogeneous, mixed echoic echogenicity and indistinct margins, involving the second and third sonographic layers of the gastric wall (arrow).
Figure 2
Figure 2
Ectopic pancreas originates from the second and third sonographic layers of the gastric wall. (a) A subepithelial tumor with intact but uneven surface was identified in the antrum. (b) Endoscopic ultrasonographic image obtained with a 12 MHz catheter probe. The tumor exhibits heterogeneous, mixed echoic echogenicity and indistinct margins, involving the second and third sonographic layers of the gastric wall (arrow).
Figure 3
Figure 3
Ectopic pancreas originates from the fourth sonographic layers of the gastric wall. (a) A subepithelial tumor with intact mucosa was identified at antrum. (b) Endoscopic ultrasonographic image obtained with a 12 MHz catheter probe. The tumor exhibits homogenous, hypoechoic echogenicity and distinct margin originating from the fourth sonographic layer of gastric wall (arrow).
Figure 4
Figure 4
Ectopic pancreas originates from the fourth sonographic layers of the gastric wall. (a) A subepithelial tumor with intact mucosa was identified at antrum. (b) Endoscopic ultrasonographic image obtained with a 12 MHz catheter probe. The tumor exhibits homogenous, hypoechoic echogenicity and distinct margin originating from the fourth sonographic layer of gastric wall (arrow).
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