Araştırma Makalesi
BibTex RIS Kaynak Göster

Retrospective Single Center Evaluation of Endosonographic Features of Ectopic Pancreas Cases

Yıl 2021, , 79 - 85, 06.04.2021
https://doi.org/10.5505/deutfd.2021.14227

Öz

INTRODUCTION: Ectopic pancreas is defined as pancreatic tissue located outside the normal pancreas. The aim of the present study was to determine the sonographic characteristics of lesions considered as ectopic pancreas via endoscopic ultrasonography examination.
METHODS: This retrospective single-center study included 53 patients diagnosed with ectopic pancreas by endoscopic ultrasonography between March 2014 and March 2020.
RESULTS: In the study, 32 (60.4%) patients were female and mean age was 44.7 ± 12.1 years. Further, 37 (69.8%) lesions were detected at the antrum greater curvature side, 10 (18.9%) at the antrum posterior wall, three (5.7%) at the corpus, two (3.8%) at the bulbus. EUS examination revealed that all lesions exhibited a heterogeneous pattern, 52 (98.1%) lesions had a hypoechoic appearance, 45 (85%) lesion borders were regular, and 45 (85%) showed central umbilication. The lesions were most frequently located in the submucosa (90.6%). The mean long axis was 10.7 ± 3.5 mm, mean short axis was 4.8 ± 1.0 mm, and long/short axis ratio was 2.4 ± 0.9. No significant difference was observed between the dimensions and size ratios of lesions and the presence or absence of umbilication (p = 0.550; 1.000 and 0.583, respectively).
DISCUSSION AND CONCLUSION: In cases where the endoscopic ultrasonography examination revealed subepithelial lesions of submucosal origin that are <2 cm in size, exhibiting a heterogeneous pattern and hypoechoic appearance, anechoic duct-like structures, and a long/short axis ratio of >1.5 along with central umbilication, the diagnosis of ectopic pancreas should be prioritized.

Kaynakça

  • Trifan A, Târcoveanu E, Danciu M, Huţanaşu C, Cojocariu C, Stanciu C. Gastric heterotopic pancreas: an unusual case and review of the literature. J Gastrointestin Liver Dis. 2012;21:209-12.
  • Burke GW, Binder SC, Barron AM, Dratch PL, Umlas J. Heterotopic pancreas: gastric outlet obstruction secondary to pancreatitis and pancreatic pseudocyst. Am J Gastroenterol. 1989;84:52–5.
  • Gupta MK, Karlitz JJ, Raines DL, Florman SS, Lopez FA. Clinical case of the month. Heterotopic pancreas. J La State Med Soc. 2010;162:310-3.
  • DeBord JR, Majarakis JD, Nyhus LM. An unusual case of heterotopic pancreas of the stomach. Am J Surg. 1981;141:269–73.
  • Yuan Z, Chen J, Zheng Q, Huang XY, Yang Z, Tang J. Heterotopic pancreas in the gastrointestinal tract. World J Gastroenterol. 2009;15:3701–3.
  • Attwell A, Sams S, Fukami N. Diagnosis of ectopic pancreas by endoscopic ultrasound with fine-needle aspiration. World J Gastroenterol. 2015;21:2367-73.
  • Nebel OT, Farrell RL, Kirchner JP, Macionus RF. Aberrant pancreas: an endoscopic diagnosis. Am J Gastroenterol. 1973;60:295-300.
  • Sathyanarayana SA, Deutsch GB, Bajaj J, Friedman B, Bansal R, Molmenti E, et al. Ectopic pancreas: A disgnostic dilema. Int J Angiol. 2012;21:177-80.
  • Elwir S, Glessing B, Amin K, Jensen E, Mallery S. Pancreatitis of ectopic pancreatic tissue: A rare cause of gastric outlet obstruction. Gastroenterol Rep (Oxf). 2017;5:237-40.
  • Perillo RP, Zuckerman GR, Shatz BA. Aberrant pancreas and leiomyoma of the stomach: indistinguishable radiologic and endoscopic features. Gastrointest Endosc. 1977;23:162-3.
  • Subasinghe D, Sivaganesh S, Perera N, Samarasekera DN. Gastric fundal heterotopic pancreas mimicking a gastrointestinal stromal tumour (GIST): a case report and a brief review. BMC Res Notes. 2016;9:185.
  • Armstrong CP, King PM, Dixon JM, Macleod IB. The clinical significance of heterotopic pancreas in the gastrointestinal tract. Br J Surg. 1981; 68:384-7.
  • Chandan VS, Wang W. Pancreatic heterotopia in the gastric antrum. Arch Pathol Lab Med. 2004;128:111-2.
  • Yoshida T, Sakamoto A, Kuroki K, Kojo A, Watanabe H, Tanaka K. Electrocoagulation biopsy of aberrant pancreas of the stomach. Am J Gastroenterol. 1976;66:554–8.
  • Matsushita M, Hajiro K, Okazaki K, Takakuwa H. Gastric aberrant pancreas: EUS analysis in comparison with the histology. Gastrointest Endoscç 1999;49:493–7.
  • Hase S, Nakazawa S, Yoshino J, Kojima Y, Niwa Y, Ohashi S. A study on gastric and small intestinal aberrant pancreas by endoscopic ultrasonography with special reference to comparison with histological appearance. Jpn J Gastroenterol. 1989;86:1684–91.
  • Geller A, Wang KK, Dimagno EP. Diagnosis of foregut duplication cysts by endoscopic ultrasonography. Gastroenterology. 1995;109:838–42.
  • Shen EF, Arnott IDR, Plevris J, Penman ID. Endoscopic ultrasonography in the diagnosis and management of suspected upper gastrointestinal submucosal tumors. Br J Surg. 2002;89:231–5.
  • Rosch T, Lorenz R, Dancygier H, Wichert AV, Classen M. Endosonographic diagnosis of submucosal upper gastrointestinal tract tumors. Scand J Gastroenterol. 1992;27:1–8.
  • Boyce GA, Sivak MV, Rosch T, Classen M, Fleischer DE. Evaluation of submucosal upper gastrointestinal tract lesions by endoscopic ultrasound. Gastrointest Endosc. 1991;37:449–54.
  • Zhou PH, Yao LQ, Zhong YS, He GJ, Xu MD, Qin XY. Role of endoscopic miniprobe ultrasonography in diagnosis of submucosal tumor of large intestine. World J Gastroenterol. 2004;10:2444–6.
  • Rösch T, Kapfer B, Will U, Baronius W, Strobel M, Lorenz R, et al. Accuracy of endoscopic ultrasonography in upper gastrointestinal submucosal lesions: a prospective multicenter study. Scand J Gastroenterol. 2002;37:856–62.
  • Karaca C, Turner BG, Cizginer S, Forcione D, Brugge W. Accuracy of EUS in the evaluation of small gastric subepithelial lesions. Gastrointest Endosc. 2010;71:722–7.
  • Changchien CS, Hsiaw CM, Hu TH. Endoscopic ultrasonographic classification of gastric aberrant pancreas. Chang Gung Med J. 2000;23:600–7.
  • Kim JH, Lim JS, Lee YC, Hyung WJ, Lee JH, Kim MJ, et al. Endosonographic features of gastric ectopic pancreases distinguishable from mesenchymal tumors. J Gastroenterol Hepatol. 2008;23:e301–e307.
  • Chen SH, Huang WH, Feng CL, Chou JW, Hsu CH, Peng CY, et al. Clinical analysis of ectopic pancreas with endoscopic ultrasonography: an experience in a medical center. J Gastrointest Surg. 2008;12:877–81.
  • Watanabe K, Irisawa A, Hikichi T, Takagi T, Shibukawa G, Sato M, et al. Acute inflammation occurring in gastric aberrant pancreas followed up by endoscopic ultrasonography. World J Gastrointest Endosc. 2012;4:331–4.
  • Park SH, Kim GH, Park DY, Shin NR, Cheong JH, Moon JY, et al. Endosonographic findings of gastric ectopic pancreas: a single center experience. J Gastroenterol Hepatol. 2011;26:1441-6.
  • Mulholland KC, Wallace WD, Epanomeritakis E, Hall SR. Pseudocyst formation in gastric ectopic pancreas. JOP. 2004;5:498–501.
  • Christodoulidis G, Zacharoulis D, Barbanis S, Katsogridakis E, Hatzitheofilou K. Heterotopic pancreas in the stomach: a case report and literature review. World J Gastroenterol. 2007;13:6098-100.
  • Gottschalk U, Dietrich CF, Jenssen C. Ectopic pancreas in the upper gastrointestinal tract: Is endosonographic diagnosis reliable? Data from the German Endoscopic Ultrasound Registry and review of the literature. Endosc Ultrasound. 2018;7:270-8.
  • Erkan N, Vardar E, Vardar R. Heterotopic pancreas: Report of two cases. JOP. 2007;8:588-91.
  • Gottschalk U, Casper B, Boden G. Ectopic pancreas presenting as a large gastric antral papilla. Endoscopy. 2003;35:547.
  • Wiech T, Walch A, Werner M. Histopathological classification of nonneoplastic and neoplastic gastrointestinal submucosal lesions. Endoscopy. 2005;37:630–4.
  • Chou JW, Cheng KS, Ting CF, Feng CL, Lin YT, Huang WH. Endosonographic features of histologically proven gastric ectopic pancreas. Gastroenterol Res Pract. 2014;2014:160601.
  • Chak A, Canto MI, Rösch T, Dittler HJ, Hawes RH, Tio TL, et al. Endosonographic differentiation of benign and malignant stromal cell tumors. Gastrointest Endosc. 1997;45:468-73.

Ektopik Pankreas Olgularının Endosonografik Özelliklerinin Retrospektif Tek Merkez Değerlendirilmesi

Yıl 2021, , 79 - 85, 06.04.2021
https://doi.org/10.5505/deutfd.2021.14227

Öz

GİRİŞ ve AMAÇ: Ektopik pankreas, normal pankreas dışında kalan pankreas dokusudur. Bu çalışmanın amacı, endoskopik ultrason incelemesi ile ektopik penakreas olduğu düşünülen lezyonların sonografik özelliklerinin belirlenmesidir.
YÖNTEM ve GEREÇLER: Çalışmamız Mart 2014–Mart 2020 tarihleri arasında endoskopik ultrason incelemesi ile ektopik pankreas tanısı konulan 53 olgunun retrospektif tek merkezli değerlendirilmesini içermektedir.
BULGULAR: Çalışmamızdaki olguların 32 (%60,4)’si kadın ve yaş ortalaması 44,7 ± 12,1 yıl saptanmıştır. Lezyonların 37 (%69,8)’si antrum büyük kurvaturda, 10 (%18,9)’u antrum posterior, üçü (%5,7) korpus, ikisi (%3,8)’bulbusta saptanmıştır. Endoskopik ultrason incelemesinde, lezyonların tamamı heterojen paternde, 52 (%98,1)’si hipoekoik görünümde, 45 (%85)’inin sınırları düzenli olduğu ve 45 (%85)’inde de santral umbilikasyon varlığı saptanmıştır. Lezyonların en sık (%90,6) submukoza yerleşimli olduğu görülmüştür. Lezyonların uzun aks ortalaması 10,7 ± 3,5 mm, kısa aks ortalaması 4,8 ± 1 mm ve uzun aks / kısa aks oranı 2,4 ± 0,9 olarak saptanmıştır. Umbilikasyon varlığı ile lezyonların boyutları ve boyut oranları arasında anlamlı farklılık saptanmamıştır (sırasıyla p = 0,550; 1,00 ve 0,583).
TARTIŞMA ve SONUÇ: Endoskopik ultrason incelemede; 2cm’den küçük, submukozal orijinli, heterojen ve hipoekoik paternli, anekoik kanal benzeri yapıların olduğu, santral umbilikasyonun eşlik ettiği, uzun aks / kısa aks oranı 1,5’den büyük olan subepitelyal lezyonların saptanması durumunda ektopik pankreas teşhisi ön planda tutulmalıdır.

Kaynakça

  • Trifan A, Târcoveanu E, Danciu M, Huţanaşu C, Cojocariu C, Stanciu C. Gastric heterotopic pancreas: an unusual case and review of the literature. J Gastrointestin Liver Dis. 2012;21:209-12.
  • Burke GW, Binder SC, Barron AM, Dratch PL, Umlas J. Heterotopic pancreas: gastric outlet obstruction secondary to pancreatitis and pancreatic pseudocyst. Am J Gastroenterol. 1989;84:52–5.
  • Gupta MK, Karlitz JJ, Raines DL, Florman SS, Lopez FA. Clinical case of the month. Heterotopic pancreas. J La State Med Soc. 2010;162:310-3.
  • DeBord JR, Majarakis JD, Nyhus LM. An unusual case of heterotopic pancreas of the stomach. Am J Surg. 1981;141:269–73.
  • Yuan Z, Chen J, Zheng Q, Huang XY, Yang Z, Tang J. Heterotopic pancreas in the gastrointestinal tract. World J Gastroenterol. 2009;15:3701–3.
  • Attwell A, Sams S, Fukami N. Diagnosis of ectopic pancreas by endoscopic ultrasound with fine-needle aspiration. World J Gastroenterol. 2015;21:2367-73.
  • Nebel OT, Farrell RL, Kirchner JP, Macionus RF. Aberrant pancreas: an endoscopic diagnosis. Am J Gastroenterol. 1973;60:295-300.
  • Sathyanarayana SA, Deutsch GB, Bajaj J, Friedman B, Bansal R, Molmenti E, et al. Ectopic pancreas: A disgnostic dilema. Int J Angiol. 2012;21:177-80.
  • Elwir S, Glessing B, Amin K, Jensen E, Mallery S. Pancreatitis of ectopic pancreatic tissue: A rare cause of gastric outlet obstruction. Gastroenterol Rep (Oxf). 2017;5:237-40.
  • Perillo RP, Zuckerman GR, Shatz BA. Aberrant pancreas and leiomyoma of the stomach: indistinguishable radiologic and endoscopic features. Gastrointest Endosc. 1977;23:162-3.
  • Subasinghe D, Sivaganesh S, Perera N, Samarasekera DN. Gastric fundal heterotopic pancreas mimicking a gastrointestinal stromal tumour (GIST): a case report and a brief review. BMC Res Notes. 2016;9:185.
  • Armstrong CP, King PM, Dixon JM, Macleod IB. The clinical significance of heterotopic pancreas in the gastrointestinal tract. Br J Surg. 1981; 68:384-7.
  • Chandan VS, Wang W. Pancreatic heterotopia in the gastric antrum. Arch Pathol Lab Med. 2004;128:111-2.
  • Yoshida T, Sakamoto A, Kuroki K, Kojo A, Watanabe H, Tanaka K. Electrocoagulation biopsy of aberrant pancreas of the stomach. Am J Gastroenterol. 1976;66:554–8.
  • Matsushita M, Hajiro K, Okazaki K, Takakuwa H. Gastric aberrant pancreas: EUS analysis in comparison with the histology. Gastrointest Endoscç 1999;49:493–7.
  • Hase S, Nakazawa S, Yoshino J, Kojima Y, Niwa Y, Ohashi S. A study on gastric and small intestinal aberrant pancreas by endoscopic ultrasonography with special reference to comparison with histological appearance. Jpn J Gastroenterol. 1989;86:1684–91.
  • Geller A, Wang KK, Dimagno EP. Diagnosis of foregut duplication cysts by endoscopic ultrasonography. Gastroenterology. 1995;109:838–42.
  • Shen EF, Arnott IDR, Plevris J, Penman ID. Endoscopic ultrasonography in the diagnosis and management of suspected upper gastrointestinal submucosal tumors. Br J Surg. 2002;89:231–5.
  • Rosch T, Lorenz R, Dancygier H, Wichert AV, Classen M. Endosonographic diagnosis of submucosal upper gastrointestinal tract tumors. Scand J Gastroenterol. 1992;27:1–8.
  • Boyce GA, Sivak MV, Rosch T, Classen M, Fleischer DE. Evaluation of submucosal upper gastrointestinal tract lesions by endoscopic ultrasound. Gastrointest Endosc. 1991;37:449–54.
  • Zhou PH, Yao LQ, Zhong YS, He GJ, Xu MD, Qin XY. Role of endoscopic miniprobe ultrasonography in diagnosis of submucosal tumor of large intestine. World J Gastroenterol. 2004;10:2444–6.
  • Rösch T, Kapfer B, Will U, Baronius W, Strobel M, Lorenz R, et al. Accuracy of endoscopic ultrasonography in upper gastrointestinal submucosal lesions: a prospective multicenter study. Scand J Gastroenterol. 2002;37:856–62.
  • Karaca C, Turner BG, Cizginer S, Forcione D, Brugge W. Accuracy of EUS in the evaluation of small gastric subepithelial lesions. Gastrointest Endosc. 2010;71:722–7.
  • Changchien CS, Hsiaw CM, Hu TH. Endoscopic ultrasonographic classification of gastric aberrant pancreas. Chang Gung Med J. 2000;23:600–7.
  • Kim JH, Lim JS, Lee YC, Hyung WJ, Lee JH, Kim MJ, et al. Endosonographic features of gastric ectopic pancreases distinguishable from mesenchymal tumors. J Gastroenterol Hepatol. 2008;23:e301–e307.
  • Chen SH, Huang WH, Feng CL, Chou JW, Hsu CH, Peng CY, et al. Clinical analysis of ectopic pancreas with endoscopic ultrasonography: an experience in a medical center. J Gastrointest Surg. 2008;12:877–81.
  • Watanabe K, Irisawa A, Hikichi T, Takagi T, Shibukawa G, Sato M, et al. Acute inflammation occurring in gastric aberrant pancreas followed up by endoscopic ultrasonography. World J Gastrointest Endosc. 2012;4:331–4.
  • Park SH, Kim GH, Park DY, Shin NR, Cheong JH, Moon JY, et al. Endosonographic findings of gastric ectopic pancreas: a single center experience. J Gastroenterol Hepatol. 2011;26:1441-6.
  • Mulholland KC, Wallace WD, Epanomeritakis E, Hall SR. Pseudocyst formation in gastric ectopic pancreas. JOP. 2004;5:498–501.
  • Christodoulidis G, Zacharoulis D, Barbanis S, Katsogridakis E, Hatzitheofilou K. Heterotopic pancreas in the stomach: a case report and literature review. World J Gastroenterol. 2007;13:6098-100.
  • Gottschalk U, Dietrich CF, Jenssen C. Ectopic pancreas in the upper gastrointestinal tract: Is endosonographic diagnosis reliable? Data from the German Endoscopic Ultrasound Registry and review of the literature. Endosc Ultrasound. 2018;7:270-8.
  • Erkan N, Vardar E, Vardar R. Heterotopic pancreas: Report of two cases. JOP. 2007;8:588-91.
  • Gottschalk U, Casper B, Boden G. Ectopic pancreas presenting as a large gastric antral papilla. Endoscopy. 2003;35:547.
  • Wiech T, Walch A, Werner M. Histopathological classification of nonneoplastic and neoplastic gastrointestinal submucosal lesions. Endoscopy. 2005;37:630–4.
  • Chou JW, Cheng KS, Ting CF, Feng CL, Lin YT, Huang WH. Endosonographic features of histologically proven gastric ectopic pancreas. Gastroenterol Res Pract. 2014;2014:160601.
  • Chak A, Canto MI, Rösch T, Dittler HJ, Hawes RH, Tio TL, et al. Endosonographic differentiation of benign and malignant stromal cell tumors. Gastrointest Endosc. 1997;45:468-73.
Toplam 36 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Araştırma Makaleleri
Yazarlar

Ali Şenkaya Bu kişi benim 0000-0002-5787-3422

Ferit Çelik Bu kişi benim 0000-0003-4459-7657

İlkçe Akgün Bu kişi benim 0000-0002-2661-8525

Fatih Tekin Bu kişi benim 0000-0002-7282-1399

Nevin Oruç Bu kişi benim 0000-0002-3057-6452

Ahmet Aydın Bu kişi benim 0000-0001-8258-828X

Yayımlanma Tarihi 6 Nisan 2021
Gönderilme Tarihi 19 Aralık 2020
Yayımlandığı Sayı Yıl 2021

Kaynak Göster

Vancouver Şenkaya A, Çelik F, Akgün İ, Tekin F, Oruç N, Aydın A. Retrospective Single Center Evaluation of Endosonographic Features of Ectopic Pancreas Cases. DEU Tıp Derg. 2021;35(1):79-85.