Published online Oct 26, 2020. doi: 10.12998/wjcc.v8.i20.4708
Peer-review started: May 11, 2020
First decision: May 21, 2020
Revised: June 8, 2020
Accepted: September 8, 2020
Article in press: September 8, 2020
Published online: October 26, 2020
Processing time: 167 Days and 19.3 Hours
Gastric heterotopic pancreas (GHP) is generally asymptomatic and rarely features complications such as pancreatitis, pseudocysts, gastric outlet obstruction, bleeding, obstructive jaundice, or intussusception. However, the treatment of complicated GHP is challenging and often requires surgical resection.
To investigate the clinical outcomes of endoscopic submucosal dissection (ESD) as alternative to surgical resection for complicated GHP.
This is a single-center, retrospective study. Between January 2013 and December 2017, a total of 5 patients underwent ESD for complicated GHP at Asan Medical Center. Patients who were diagnosed with complicated GHP were treated conservatively as with general practice for acute pancreatitis. After conservative management for resolving the acute phase of pancreatitis, ESD was performed as definitive treatment for complicated GHP. ESD was performed using the conventional method under conscious sedation. The clinical features of patients and tumors, procedure-related characteristics, and long-term outcomes were investigated.
The age of the 5 patients ranged from 28-43 years. Two of the patients were males. All lesions were located in the greater curvature of the antrum. On endoscopic ultrasonography during the pain episode, all lesions were located across the muscularis mucosa, submucosa, and proper muscle layers. The median lesion size was 20 [interquartile range (IQR), 18-35] during the pain episode at the time of the diagnosis of complicated GHP, and 15 mm (IQR, 9-33) at the time of ESD after conservative treatment. The procedure time ranged from 15-120 min. There were no procedure-related adverse events such as perforation or bleeding. The length of hospital stay after the procedure ranged from 2-4 d. All patients were symptom free during the median follow-up period of 46.0 mo (IQR, 39-60).
ESD appears to be a feasible and effective treatment option for complicated GHP based on the favorable clinical outcomes.
Core Tip: Treatment of complicated gastric heterotopic pancreas (GHP) is challenging and often requires surgical resection like gastrectomy. We experienced several cases of complicated GHP with pseudocyst that was treated successfully with endoscopic submucosal dissection (ESD), and there were no procedure-related adverse events. All patients were symptom free during the median follow-up period and patients consequently could preserve their stomach. Our findings suggested that ESD can be a feasible minimally invasive treatment alternative to surgical resection.