Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Sep 16, 2021; 13(9): 437-446
Published online Sep 16, 2021. doi: 10.4253/wjge.v13.i9.437
Ectopic pancreas at the ampulla of Vater diagnosed with endoscopic snare papillectomy: A case report and review of literature
Manoj A Vyawahare, Naga Bharati Musthyla
Manoj A Vyawahare, Department of Medical Gastroenterology, American Oncology Institute at Nangia Specialty Hospital, Nagpur 440028, Maharashtra, India
Naga Bharati Musthyla, Department of Pathology, AmPath Central Reference Laboratory, Hyderabad 500019, Telangana, India
Author contributions: Vyawahare MA contributed to conception and design of the study; Vyawahare MA and Musthyla NB contributed to collection, analysis and interpretation of the data, drafting, critical revision and final approval of the manuscript.
Informed consent statement: The study participant, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Manoj A Vyawahare, MD, Chief Doctor, Department of Medical Gastroenterology, American Oncology Institute at Nangia Specialty Hospital, C1/1, opposite MIA Centre for Sports and Recreation, MIDC, Hingna, Nagpur 440028, Maharashtra, India. drmanojvyawahare@gmail.com
Received: March 5, 2021
Peer-review started: March 5, 2021
First decision: May 5, 2021
Revised: May 14, 2021
Accepted: July 5, 2021
Article in press: July 5, 2021
Published online: September 16, 2021
Processing time: 188 Days and 23.9 Hours
Abstract
BACKGROUND

Ectopic pancreas is a rare developmental anomaly that results in a variety of clinical presentations. Patients with ectopic pancreas are mostly asymptomatic, and if symptomatic, symptoms are usually nonspecific and determined by the location of the lesion and the various complications arising from it. Ectopic pancreas at the ampulla of Vater (EPAV) is rare and typically diagnosed after highly morbid surgical procedures such as pancreaticoduodenectomy or ampullectomy. To our knowledge, we report the first case of confirmed EPAV with a minimally invasive intervention.

CASE SUMMARY

A 71-year-old male with coronary artery disease, presented to us with new-onset dyspepsia with imaging studies revealing a ‘double duct sign’ secondary to a small subepithelial ampullary lesion. His hematological and biochemical investigations were normal. His age, comorbidity, poor diagnostic accuracy of endoscopy, biopsies and imaging techniques for subepithelial ampullary lesions, and suspicion of malignancy made us acquire histological diagnosis before morbid surgical intervention. We performed balloon-catheter-assisted endoscopic snare papillectomy which aided us to achieve en bloc resection of the ampulla for histopathological diagnosis and staging. The patient’s post-procedure recovery was uneventful. The en bloc resected specimen revealed ectopic pancreatic tissue in the ampullary region. Thus, the benign histopathology avoided morbid surgical intervention in our patient. At 15 mo follow-up, the patient is asymptomatic.

CONCLUSION

EPAV is rare and remains challenging to diagnose. This rare entity should be included in the differential diagnosis of subepithelial ampullary lesions. Endoscopic en bloc resection of the papilla may play a vital role as a diagnostic and therapeutic option for preoperative histological diagnosis and staging to avoid morbid surgical procedures.

Keywords: Ectopic pancreas; Heterotopic pancreas; Ampulla of Vater; Endoscopic snare papillectomy; Ampullary tumors; Case report

Core Tip: Ectopic pancreas at the ampulla of Vater (EPAV) is an extremely rare condition, usually mimicking malignancy and presents as abdominal pain and obstructive jaundice. This rare entity should be included in the differential diagnosis of subepithelial ampullary lesions. The diagnosis of EPAV remains very challenging despite several endoscopic and radiological advances. The diagnosis is usually based on morbid surgical interventions such as pancreaticoduodenectomy/ampullectomy or autopsy. Endoscopic en bloc resection of the papilla with endoscopic snare papillectomy may play a vital role as a diagnostic and therapeutic option for preoperative histological diagnosis and staging to avoid morbid surgical procedures.