Noh JH, Kim DH, Kim SW, Park YS, Na HK, Ahn JY, Jung KW, Lee JH, Choi KD, Song HJ, Lee GH, Jung HY. Endoscopic submucosal dissection as alternative to surgery for complicated gastric heterotopic pancreas. World J Clin Cases 2020; 8(20): 4708-4718 [PMID: 33195638 DOI: 10.12998/wjcc.v8.i20.4708]
Corresponding Author of This Article
Do Hoon Kim, MD, PhD, Associate Professor, Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea. dohoon.md@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Oct 26, 2020; 8(20): 4708-4718 Published online Oct 26, 2020. doi: 10.12998/wjcc.v8.i20.4708
Endoscopic submucosal dissection as alternative to surgery for complicated gastric heterotopic pancreas
Jin Hee Noh, Do Hoon Kim, So-Woon Kim, Young Soo Park, Hee Kyong Na, Ji Yong Ahn, Kee Wook Jung, Jeong Hoon Lee, Kee Don Choi, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung
Jin Hee Noh, Do Hoon Kim, Hee Kyong Na, Ji Yong Ahn, Kee Wook Jung, Jeong Hoon Lee, Kee Don Choi, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung, Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
So-Woon Kim, Young Soo Park, Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
Author contributions: All authors contributed to the study design and data collection, Noh JH, Kim DH contributed to material preparation, data collection and analysis; Noh JH, Kim DH contributed to writing the first draft of the manuscript; all authors edited on previous versions of the manuscript; and all authors read and approved the final manuscript.
Institutional review board statement: This study was approved by the institutional review board of Asan Medical Center (IRB No. 2019-0963).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Do Hoon Kim, MD, PhD, Associate Professor, Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea. dohoon.md@gmail.com
Received: May 11, 2020 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
ARTICLE HIGHLIGHTS
Research background
Gastric heterotopic pancreas (GHP) is generally asymptomatic and rarely features complications. However, the treatment of complicated GHP is challenging and often requires surgical resection.
Research motivation
This retrospective study describes clinical outcomes in patients who underwent endoscopic submucosal dissection (ESD) for complicated GHP.
Research objectives
This study aimed to investigate the clinical outcomes of ESD as alternative to surgical resection for complicated GHP.
Research methods
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. The clinical features of patients and tumors, procedure-related characteristics, and long-term outcomes were investigated.
Research results
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 during the pain episode at the time of the diagnosis of complicated GHP, and 15 mm 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.
Research conclusions
When patients with GHP experience recurrent severe acute abdominal pain, complicated GHP should be considered as a differential diagnosis.
Research perspectives
Conservative treatment followed by ESD can be a feasible minimally invasive alternative to surgical resection.
