Clinical classification of symptomatic heterotopic pancreas of the stomach and duodenum: A case series and systematic literature review

Table 1 Pathologic specimens identified with heterotopic pancreas; specimens are divided into symptomatic classification

Clinical features	n	Percent
Total patients	29	100%
Symptomatic HP	6	20.0%
Pancreatitis	2	7.0%
Bleeding/anemia	2	7.0%
Peptic ulceration	1	3.4%
Gastric outlet obstruction	1	3.4%
Asymptomatic HP	23	80.0%
Incidental finding on pathology	5	17.2%
Noted on Endoscopy	17	58.6%
Identified at time of surgery	1	3.4%

HP: Heterotopic pancreas.

Table 2 Summary of systematic literature review listed by publication, number of symptomatic cases, demographics and clinical symptoms

Ref.	Year		Total patients	Symptomatic patients	Mean age	Gastric lesions	Duodenal lesions	Location other than foregut	Abdominal Pain	Dyspepsia	Gastrointestinal Bleeding	Pancreatitis	Gastric outlet obstruction	Perforation	Nausea	Jaundice
Noh et al[5]	2019		5	5	32	5			5			5
Zhou et al[6]	2019		93	78	39.75	78			38	41					4
Betzler et al[7]	2017		67	11	53		11		8			7
Jun et al[8]	2017		165	79	45.2	46	18	15	64	64					64
Zhang et al[9]	2016		184	26	49	25	1		26	26						1
Liao et al[10]	2014		2	2	36	2				2
Chou et al[11]	2014		13	13	40.8	13			6	7
Endo et al[12]	2014		2	2	74	1	1		1		1
Liu et al[13]	2013		9	9	48.3	9			6	9			1
Zhong et al[14]	2013		60	30	39	30			16	24	6
Shah et al[15]	2011		30	4	53	1	1	2	1			1	1
Park et al16]	2011		26	9	34	9			4	9
Wei et al[17]	2011		11	11	52	3	8		6	8	3				2
Ryu et al18]	2010		8	4	36	4				4
Yuan et al[19]	2009		2	2	61		1	1	1	1
Khashab et al[20]	2009		2	2	32	2				1	1
Casetti et al[21]	2009		58	58	44.7		58		46	1		58
Jovanovic et al[22]	2008		13	13	41.5		13		10			6	1		7	4
Chen, H et al[23]	2008		39	15	46	12	1	2	9	9	5
Chen, S et al[24]	2008		20	13	39	12	1		9	4
Rebours et al[25]	2007		105	105	46		105		91		5	105			30	13
Tison et al[26]	2007		9	9	49.6		9		8			9	9			1
Ormarsson et al[4]	2006		30	11	49.2	11			5	5					1
Pessaux et al[27]	2006		12	12	42.4		12		11		1	12			8
Ayantunde et al[28]	2006		3	3	55	3			1	1			2		2
Chatelain et al[29]	2005		2	2	40.5		2		2			2	2
Zinkiewicz et al[30]	2003		12	7	34	6	1		7	7
Shi et al[31]	2002		7	7	41	1	4	2		2	1		1			3
Huang et al[32]	2002		2	2	46	2							2
Otani et al[33]	2000		34	2	43	2			1	1
Hsia et al[34]	1999		17	10	47.5	8	2			8	2
Fekete et al[35]	1996		6	6	40	1	5		6		1	6
Flejou et al[36]	1993		10	10	41	1	9		7		1	10				2
Claudon et al[37]	1988		2	2	41	2			2	2
Pang et al[38]	1988		32	14	44	3	4	7	6	5	2				1	1
Lai et al[39]	1986		37	9	50	6	3		7	7	1		1
Mollitt et al[40]	1984		9	6	6.8	6			3	3			3
Armstrong et al[41]	1981		34	13	51	5	5	3		11	2
Thoeni et al[42]	1980		9	6	43	6			1	1	1	1	1
Yamagiwa et al[43]	1977		64	26	45.2	23	3		17	15	4				8
Dolan et al[44]	1974		212	73	60	43	25	5	52	46	7				1
Eklof et al[45]	1973		4	4	7	3	1		3	2					1
Nebel et al[46]	1973		3	3	28	1	2		3	3
McGarity et al[47]	1971		2	2	33	2				2			1		2
Abrahams et al[48]	1966		9	9	49.8	5	4			9	6
Tonkin et al[49]	1962		4	4	44	2	2		3	4			1
Dirks et al[50]	1961		3	3	44.6	0	3		3	2	1
Martinez et al[51]	1958		51	28	43.1	21		7	16	19	2		3
Waugh et al[52]	1946		5	5	34.8	5			3	3	2
De Castro Barboso et al[1]	1947		41	17	43	10	7		10	11	4
Single case studies (n = 182)[3,53-233]			182	182	39.1	126	56		96	66	21	38	51	3	57	12
Total			1761	978	43	556	378	44	620	445	80	260	80	3	188	37

Table 3 Treatment of heterotopic pancreas; listing of surgical or endoscopic procedures performed for patients with symptomatic heterotopic pancreas by procedure

Procedure	n	Percent (%)
Distal gastrectomy	84	10.50
Billroth I reconstruction	14	1.70
Billroth II reconstruction	64	8.00
Roux-en-Y reconstruction	6	0.75
Gastric wedge resection	81	10.00
Subtotal gastrectomy	18	2.25
Total gastrectomy	5	0.63
Gastrotomy and local excision	42	5.30
Partial gastrectomy NOS	215	27.00
Pancreaticoduodenectomy	168	21.00
Trans-duodenal excision	19	2.40
Partial duodenectomy	7	0.90
Ampullectomy	2	0.25
Endoscopic submucosal excision	158	19.77
Total procedures	799	100.00