Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
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
Abstract
BACKGROUND

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.

AIM

To investigate the clinical outcomes of endoscopic submucosal dissection (ESD) as alternative to surgical resection for complicated GHP.

METHODS

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.

RESULTS

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).

CONCLUSION

ESD appears to be a feasible and effective treatment option for complicated GHP based on the favorable clinical outcomes.

Keywords: Endoscopic submucosal dissection; Gastric; Heterotopic pancreas; Pancreatitis

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.