Endosonogragphic features of lesions suggesting gastricectopic pancreas: experience of a single tertiary center

Abstract

Background/aim: We aimed to present the endoscopic ultrasound (EUS) features of gastric lesions suggesting gastric ectopic pancreas during upper gastrointestinal endoscopy that were diagnosed in our gastroenterology unit, which is a tertiary center for endoscopic procedures in Turkey. Materials and methods:The data of patients who underwent upper gastrointestinal EUS in our center between April 2012 and July 2014 were retrospectively analyzed.Results: All of the lesions suggesting gastric ectopic pancreas were localized in the gastric antrum. Thirty-six of 44 lesions (81.1%) showed central dimpling. Lesion borders were shown to be definite in 10 (22.7%) lesions, whereas the borders of 34 lesions (77.3%) were indefinite. Thirty-nine lesions (88.6%) had heterogeneous and 5 lesions (11.4%) had homogeneous echo patterns; whereas 29 lesions (65.9%) were hypoechoic, 9 lesions (20.5%) were hyperechoic and 6 lesions (13.6%) had mixed echogenicity. Forty-two lesions (95.5%) were shown to affect only a single sonographic layer of the gastric wall. Conclusion:EUS features of lesions that strongly suggest gastric ectopic pancreas endoscopically, without any histopathological evidence and without either endoscopic or surgical resection, are as follows: indefinite border appearance, minimal heterogeneous hypoisoechoic echo pattern, existence of anechoic duct-like structures inside the lesion, common localization in the submucosal layer, and existence of umbilication.

Gastric Ectopic Pancreas With Pseudocyst Formation Causing Gastric Outlet Obstruction

“…A characteristic central dimpling of the mucosa, which represents a ductal opening, has been reported in 34%–81% of cases. 12 , 13 EUS is the procedure of choice to evaluate submucosal lesions, and ectopic pancreas should be on the differential diagnosis, particularly if the lesion is in the prepyloric region of the stomach. EUS features include indistinct borders (77%), heterogenous echotexture (88%), and an anechoic duct-like structure.…”

“…EUS features include indistinct borders (77%), heterogenous echotexture (88%), and an anechoic duct-like structure. 12 In a case series of 26 patients, Park et al 13 noted that 76% of gastric ectopic pancreatic lesions involved 2 or more sonographic layers on EUS. The diagnosis of ectopic pancreas often requires endoscopic or surgical resection for histopathologic confirmation.…”

Diagnostic yields of endoscopic ultrasound-guided fine-needle tissue acquisition according to the gastric location

“…Suzuki et al [25] suggested that it was more di cult to maintain a scope stably in the lower third area of the stomach. In addition, it is known that ectopic pancreas is more frequently detected in the antrum compared with corpus or cardia [26][27][28][29]. Ectopic pancreas is a heterogeneous lesion associated with muscular wall thickening, so it might be di cult to obtain adequate tissue from ectopic pancreas using EUS-FNTA [30].…”

“…In addition, it is known that ectopic pancreas is more frequently detected in the antrum than it is in the corpus or cardia. [ 26 – 29 ] Ectopic pancreas is a heterogeneous lesion associated with muscular wall thickening; therefore, it might be difficult to obtain adequate tissue from ectopic pancreas using EUS-FNTA. [ 30 ]…”

“…In addition, it is known that ectopic pancreas is more frequently detected in the antrum than it is in the corpus or cardia. [26][27][28][29] Ectopic pancreas is a heterogeneous lesion associated with muscular wall thickening; therefore, it might be difficult to obtain adequate tissue from ectopic pancreas using EUS-FNTA. [30] Recently, an electrocautery-enhanced delivery system was applied to facilitate self-expandable metal stent insertion under combined endoscopic and EUS guidance.…”