| ObjectiveWith the development of endoscopic techniques,the detection rate of asymptomatic ectopic pancreas was increasing,but there is insufficient experience in diagnosis of ectopic pancreas by endoscopy in clinical works.This study retrospectively analyzed the clinical characteristics,endosonographic features of pathologically confirmed ectopic pancreas,and followed up the patients diagnosed with ectopic pancreas by endoscopic ultrasonography(EUS).MethodsWe searched the pathology database of our hospital(the Sir Run Run Shaw Hospital,affiliated to Zhejiang university school of medicine)by using the term of"ectopic pancreas",from January 2001 to March 2019.A total of 78 patients confirmed with ectopic pancreas by pathology and examined by EUS(group A)were retrieved.We retrospectively analyzed the patients' demographic characteristics,main symptoms at the time of presentation,and endosonographic features.The endosonographic features include the size,the boundary,the original layer,the echo intensity and homogeneity.In addition,we retrieved patients diagnosed with ectopic pancreas by EUS from January 2001 to March 2019.201 suspected ectopic pancreas patients who underwent endoscopy regularly(group B)were followed up by reviewing endoscopy,calling or writing letters.Then we retrospectively analyzed the pathological diagnosis distribution of 61 patients who had pathological results,and the endosonographic features of 34 patients who were confirmed with ectopic pancreas by pathology.Results1.General information:Group A:There were 78 patients confirmed with ectopic pancreas by pathology and examined by EUS totally,including 41 females(52.6%)and 37 males(47.4%).The age ranged from 16 to 75 years,with an average of 44,7±13.7 years.Most patients have no specific clinical manifestations,there were only 5 cases(4.9%)caused specific related symptoms,including gastrointestinal bleeding(1 cases,1.3%),hypoglycemia(1 case,1.3%),obstructive jaundice(1 case,1.3%)and gastrointestinal obstruction(2 cases,2.6%),which were associated with the location and size.Group B:A total of 201 patients were diagnosed with ectopic pancreas by EUS who underwent endoscopy regularly,the median follow-up time was 28 months.61 patients underwent endoscopic or surgical resection.The average size of the preoperative lesion was 14.1±8.3mm.Among them,34 cases were confirmed with ectopic pancreas by pathology,and the other 27 cases were polyp(14 cases),leiomyoma(2 cases),dysplasia(2 cases),stromal tumor(2 cases),fibrous tissue(2 cases),chronic inflammation(1 case),tuberculosis(1 case),deep cystic gastritis(1 case),lipoma(1 case)and neuroendocrine tumor(1 case).2.Endoscopic ultrasonography features:The maximum diameter of ectopic pancreas was between 5.0 and 50.0 millimeter(mm),with an average diameter of 14.9±8.4mm.Ectopic pancreas was most located at the gastric antrum(60.3%),with smooth surface mucosa(85.9%).The typical features of the ectopic pancreas mainly appeared as undefined borders(82.4%),medium echo(67.6%),heterogeneous(88.2%)lesions,and the submucosa(38.2%)or multiple layers(47.1%)involvement were more common.Nearly half of the lesions had central dimpling(47.1%)and anechoic structure(44.1%).Hypoechoic lesions originating from the muscularis propria are easy to be misdiagnosed.3.Follow-up analysis:Among the 201 patients who underwent endoscopy regularly,only 1 patient developed hemorrhage,and the remaining patients' symptoms were similar or improved.82.5%patients could review EUS at the interval of 1-2 years among 63 patients who underwent EUS regularly in our hospital,and only 4 lesions increased by 50%in size.Conclusion1.Ectopic pancreas is easily confused with other submucosal lesions under EUS.(1)Typical ectopic pancreas has specific endosonographic features:located in the greater curvature of the gastric antrum,originating from the third layer or multiple layers,medium echo,undefined border and heterogeneous.(2)Ectopic pancreas also needs to be considered in hypoechoic lesions originating from muscularis propria.(3)For lesions with a diameter greater than 10mm that are located in the gastric antrum and originate from the second and/or third layer,it is necessary to exclude inflammatory fibrous polyps before diagnosing the ectopic pancreas.2.For patients with gastrointestinal bleeding,jaundice,gastrointestinal obstruction or hypoglycemia that are difficult to be diagnosed,ectopic pancreas needs to be considered.3.EUS surveillance at the interval of 1-2 years is a relatively safe strategy for asymptomatic ectopic pancreas patients. |
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