Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2015; 21(8): 2367-2373
Published online Feb 28, 2015. doi: 10.3748/wjg.v21.i8.2367
Diagnosis of ectopic pancreas by endoscopic ultrasound with fine-needle aspiration
Augustin Attwell, Sharon Sams, Norio Fukami
Augustin Attwell, Norio Fukami, Division of Gastroenterology, Department of Medicine, University of Colorado-Denver School of Medicine, Aurora, CO 80045, United States
Sharon Sams, Department of Pathology, University of Colorado-Denver School of Medicine, Aurora, CO 80045, United States
Author contributions: Attwell A drafted, edited, and revised the manuscript and performed half of the endoscopic ultrasound procedures; Fukami N reviewed and edited the manuscript for intellectual and statistical content and performed half of the endoscopic ultrasound procedures; Sams S reviewed the cytology slides for the patients, she also produced and edited the cytology photograph image used in figure 2C.
Open-Access: 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/
Correspondence to: Augustin Attwell, MD, Division of Gastroenterology, Department of Medicine, University of Colorado-Denver School of Medicine, 660 Bannock Street, MC 4000, Denver, CO 80204, United States. augustin.attwell@dhha.org
Telephone: +1-303-6025013 Fax: +1-303-6025055
Received: September 8, 2014
Peer-review started: September 9, 2014
First decision: October 14, 2014
Revised: October 30, 2014
Accepted: November 19, 2014
Article in press: November 19, 2014
Published online: February 28, 2015
Processing time: 172 Days and 17.6 Hours
Abstract

AIM: To study the clinical, endoscopic, sonographic, and cytologic features of ectopic pancreas (EP).

METHODS: This was a retrospective study performed at an academic referral center including two hospitals. Institutional review board approval was obtained. Patients referred to the University Hospital or Denver Health Medical Center Gastrointestinal Endoscopy Lab for gastroduodenal subepithelial lesions (SEL) with a final diagnosis of EP between January 2009 and December 2013 were identified. Patients in this group were selected for the study if they underwent endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) or deep biopsy. A review of the medical record was performed specifically to review the following information: presenting symptoms, endoscopic and EUS findings, computed tomography or magnetic resonance imaging findings, pathology results, procedure-related adverse events, and subsequent treatments after EUS-FNA. EUS with FNA or deep submucosal biopsy was performed in all patients on an outpatient basais by one of two physicians (Attwell A, Fukami N). Review of all subsequent clinic notes and operative reports was performed in order to determine follow-up and final diagnoses.

RESULTS: Between July 2009 and December 2013, 10 patients [3 males, 7 females, median age 52 (26-64) years] underwent EUS for a gastroduodenal SEL and were diagnosed with EP. One patient was symptomatic. Six (60%) lesions were in the antrum, 3 (30%) in the body, and 1 (10%) in the duodenum. A mucosal dimple was noted in 6 (60%). Mean lesion size was 17 (8-25) mm. Gastrointestinal wall involvement: muscularis mucosae, 10%; submucosa, 70%; muscularis propria, 60%; and serosa, 10%. Nine (90%) lesions were hypoechoic and 5 (50%) were homogenous. A duct was seen in 5 (50%). FNA was attempted in 9 (90%) and successful in 8 (80%) patients after 4 (2-6) passes. Cytology showed acini or ducts in 7 of 8 (88%). Superficial biopsies in 7 patients (70%) showed normal gastric mucosa. Deep endoscopic biopsies were taken in 2 patients and diagnostic in one. One patient (10%) developed pancreatitis after EUS-FNA. Two patients (20%) underwent surgery to relieve symptoms or confirm the diagnosis. The main limitation of the study was the fact that it was retrospective and performed at a single medical center.

CONCLUSION: EUS features of EP include antral location, mucosal dimple, location in layers 3-4, and lesional duct, and FNA or biopsy is accurate and effective.

Keywords: Endoscopic ultrasound; Pancreatitis; Ectopic pancreas; Endoscopy; Subepithelial mass

Core tip: Subepithelial lesions (SEL) of the upper gastrointestinal (GI) tract are common incidental findings during GI endoscopy. Ectopic pancreas (EP) is an uncommon yet innocent SEL that should be differentiated from premalignant lesions such as gastrointestinal stromal tumors or neuroendocrine tumors. Noninvasive studies such as computed tomography, magnetic resonance imaging, or standard mucosal biopsies cannot reliably diagnose EP, so the role of endoscopic ultrasound-fine-needle aspiration (EUS-FNA) was studied. Herein the endoscopic, endosonographic, cytologic, and histologic features of EP are presented along with a summary of the pertinent, existing literature. Our data support the conclusion that EUS-FNA is a safe and effective diagnostic tool for EP.