Abstract:

Objective   To evaluate endoscopic ultrasonography (EUS) as used in the diagnosis and treatment of gastric heterotopic pancreas. Methods   Data from 36 patients with pathologically confirmed heterotopic pancreas were retrospectively studied. These patients received diagnosis and treatment in our hospital during the time from May 2004 to May 2010. Clinical manifestations and EUS images were documented, and appropriate endoscopic resection or surgery procedures were performed. Follow-up was done for periods between 3 months and 1 year. Results   Gastric heterotopic pancreas was frequently found in the antrum (29/36, 80.5%), with its greater curvature being a high risk site (19/36, 52.7%). In 25 cases (69.4%), the lesions were found by endoscopy to have umbilicate pits with an opening in the center. It was further confirmed by EUS that in a great majority of the cases (32/36, 88.8%) the lesions originated from the mucosa/submucosa with hyper-echo or mixed echo. Most cases had a clear outline (29/36, 80.6%), but in many being irregular (27/36, 75%). In 7 cases (19.4%), the lesions were characterized by a tube-like echo in the center. Results from the follow-up suggested that in 12 patients (33.3%) their clinical symptoms disappeared after the treatment. Conclusion   Endoscopy, together with EUS, is a useful tool for properly diagnosing heterotopic pancreas in the stomach. Endoscopic mucosal resection (EMR), and especially Cap-EMR, is desirable for cases without the muscularis propria involved and lesion diameter below 15 mm. Surgery is preferred for cases with the muscularis propria involved. For those who have abdominal pain or discomfort, endoscopic treatment is recommended.

Key words: Heterotopic pancreas; Endoscopic ultrasonography; Therapy; Endoscopic mucosal resection