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. 2023 Dec 27;15(12):2799-2808.
doi: 10.4240/wjgs.v15.i12.2799.

Laparoscopic resection and endoscopic submucosal dissection for treating gastric ectopic pancreas

Affiliations

Laparoscopic resection and endoscopic submucosal dissection for treating gastric ectopic pancreas

Hui-Da Zheng et al. World J Gastrointest Surg. .

Abstract

Background: Gastric ectopic pancreas (GEP) is a rare developmental abnormality that refers to the existence of pancreatic tissue in the stomach with no anatomical relationship with the main pancreas. It is usually difficult to diagnose through histological examination, and the choice of treatment method is crucial.

Aim: To describe the endoscopic ultrasound characteristics of GEP and evaluate the value of laparoscopic resection (LR) and endoscopic submucosal dissection (ESD).

Methods: Forty-nine patients with GEP who underwent ESD and LR in the Second Affiliated Hospital of Fujian Medical University from May 2018 to July 2023 were retrospectively included. Data on clinical characteristics, endoscopic ultrasonography (EUS), ESD, and LR were collected and analyzed. The characteristics of EUS and the efficacy of the two treatments were analyzed.

Results: The average age of the patients was 43.31 ± 13.50 years, and the average maximum diameter of the lesions was 1.55 ± 0.70 cm. The lesion originated from the mucosa in one patient (2.04%), from the submucosa in 42 patients (85.71%), and from the muscularis propria in 6 patients (12.25%). Twenty-nine patients (59.20%) with GEP showed umbilical depression on endoscopy. The most common initial symptom of GEP was abdominal pain (40.82%). Tumor markers, including carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA-19-9), were generally within the normal range. One patient (2.04%) with GEP had increased CEA and CA-19-9 levels. However, no cancer tissue was found on postoperative pathological examination, and tumor markers returned to normal levels after resecting the lesion. There was no significant difference in surgery duration (72.42 ± 23.84 vs 74.17 ± 12.81 min) or hospital stay (3.70 ± 0.91 vs 3.83 ± 0.75 d) between the two methods. LR was more often used for patients with larger tumors and deeper origins. The amount of bleeding was significantly higher in LR than in ESD (11.28 ± 16.87 vs 16.67 ± 8.76 mL, P < 0.05). Surgery was associated with complete resection of the lesion without any serious complications; there were no cases of recurrence during the follow-up period.

Conclusion: GEP has unique characteristics in EUS. LR and ESD seem to be good choices for treating GEP. LR is better for large GEP with a deep origin. However, due to the rarity of GEP, multicenter large-scale studies are needed to describe its characteristics and evaluate the safety of LR and ESD.

Keywords: Ectopic pancreas; Endoscopic submucosal dissection; Endoscopic ultrasonography; Laparoscopic resection.

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Conflict of interest statement

Conflict-of-interest statement: We have no financial relationships to disclose.

Figures

Figure 1
Figure 1
Endoscopic submucosal dissection. A: Ectopic pancreas was located in the gastric antrum; B: Marked incision line; C: The surrounding tissues of the tumor along the marker were cut; D: Complete tumor resection; E: Intraoperative precautions. F: Removal of the lesions.
Figure 2
Figure 2
Laparoscopic resection. A: Laparoscopic view of tumor resection using laparoscopic linear anastomosis; B: Laparoscopic view of wedge resection after incision of the gastric wall to exsanguinate the tumor; C: Suture and reinforcement of the remnant gastric wall; D: Pathological specimen.
Figure 3
Figure 3
Pathological view of a gastric ectopic pancreas. A: Pancreatic tissue (black arrow) and gastric mucosal tissue (white arrow), (magnification, × 40); B: Numerous acini (orange arrow) were observed in pancreatic tissue (magnification, × 100); C: Ducts were observed in the pancreatic tissue (white arrow) (magnification, × 100); D: Islet cells were observed in the pancreatic tissue (orange arrow) (magnification, × 200).
Figure 4
Figure 4
Computed tomography images and endoscopic ultrasound images. A: The arterial phase of enhanced computed tomography showed thickening of the gastric antrum (orange arrow); B: Lesion morphology on endoscopic ultrasound (white arrow).

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