Endoscopic submucosal dissection as alternative to surgery for complicated gastric heterotopic pancreas

Figure 1 Endoscopic submucosal dissection of complicated gastric heterotopic pancreas (patient 5). A: Endoscopic ultrasonography image showing a homogeneous hypoechoic lesion with cystic (hypoechoic) foci that was located within the 2^nd, 3^rd, and 4^th layers; B: A 1.5 cm subepithelial tumor with umbilication was observed on the greater curvature of the antrum; C: The lesion borders were marked; D: Saline with epinephrine was submucosally injected, and a circumferential mucosal incision was made; E: The submucosal connective tissue and part of the muscularis propria were dissected; F: The resected specimen was fixed; G: Heterotopic pancreas is located in the submucosa underlying intact gastric mucosa (hematoxylin-eosin; original magnification, × 40); H: Normal pancreatic acini with ducts are noted (× 200).