Heterotopic pancreas presenting as dysphagia

Abstract

Heterotopic pancreatic tissue, also known as a pancreatic rest, is an uncommon congenital anomaly defined as extrapancreatic tissue located far from the pancreas and without connection via vascular or anatomical means to it. Such tissue may occur throughout the GI tract but has a propensity to affect the stomach and the proximal small intestine. The majority of patients with pancreatic heterotopia are asymptomatic, but when symptoms occur, they can present in a variety of ways. We report a case of a patient whose pancreatic rest presented primarily as dysphagia for solid food and in whom endoscopic ultrasound was used to further define the lesion. There have been only two cases reported of a pancreatic rest causing symptoms of dysphagia. A review of the literature on pancreatic heterotopia as well as the use of endoscopic ultrasound as an aid in evaluation is included.

Endoscopic mucosal resection/endoscopic submucosal dissection for gastric heterotopic pancreas

“…On EUS, HP often appears as a solid submucosal mass of low echogenicity compared to the hyperechoic submucosa, and it is isoechoic to the hypoechoic muscularis propria layer (14). In our patient group, however, only 63,6% (38/60) were hypoechoic.…”

Ligation-assisted endoscopic mucosal resection of gastric heterotopic pancreas

“…Nevertheless, Shalaby et al [18] reported a case of esophageal HP diagnosed with biopsies obtained with a jumbo forceps. Teixeira [19] has described the use of ethanol injection to create an artificial ulcer that then facilitated the removal of sufficient submucosal tissue to establish the diagnosis of HP.…”

Therapeutic Management of Submucosal Gastric Tumors: A Series of Six Cases with Ectopic Pancreas in the Stomach and Description of a Novel Endoscopic Full-Thickness Resection Technique of the Gastric Wall

“…According to Shalaby et al a second biopsy using jumbo forceps allowed for retrieval of a representative specimen [5]. Pre-interventional biopsy showed ectopic pancreas in only one of the five biopsied patients (case 1).…”

“…Ectopic pancreas is most commonly found in the upper GI-Tract (in 90% of all cases in the stomach, duodenum or upper jejunum) [3]. The highest incidence of ectopic pancreas occurs in the 4 th , 5 th and 6 th decade, 2-3 times more frequently in males [4,5]. The condition is usually asymptomatic and may become clinically evident when complicated by pancreatitis [6], malignancy [7,8], obstruction [9], ulceration and bleeding [10,11].…”