Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2023; 15(12): 2799-2808
Published online Dec 27, 2023. doi: 10.4240/wjgs.v15.i12.2799
Laparoscopic resection and endoscopic submucosal dissection for treating gastric ectopic pancreas
Hui-Da Zheng, Qiao-Yi Huang, Yun-Huang Hu, Kai Ye, Jian-Hua Xu
Hui-Da Zheng, Yun-Huang Hu, Kai Ye, Jian-Hua Xu, Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
Qiao-Yi Huang, Department of Gynaecology and Obstetrics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
Co-corresponding authors: Kai Ye and Jian-Hua Xu.
Author contributions: Zheng HD made the concept and designed the present study; Zheng HD, Hu YH collected data and written the articles; Zheng HD, Huang QY prepared the original draft; Ye K and Xu JH supervised the work, provided expert insights and made critical revisions related to important intellectual content of the manuscript; all authors have read and approved the final manuscript. Ye K and Xu JH provided great help in our study process and provided important clinical advice, which made the study more clinical value and better service for clinical work; after the completion of the paper, the final review steps were carried out, and the format, grammar, pictures, tables and other aspects were revised to ensure the rigor and fluency of the study, and the unreasonable study content was critically revised, making an important contribution to ensuring the rationality and correctness of the study.
Supported by Fujian Province Science and Technology Innovation Joint Fund Project, No. 2021Y9029.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of The Second Affiliated Hospital of Fujian Medical University.
Informed consent statement: As the study used anonymous and pre-existing data, the requirement for the informed consent from patients was waived.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian-Hua Xu, MD, Chief Physician, Dean, Research Dean, Surgeon, Surgical Oncologist, Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou 362000, Fujian Province, China. xjh630913@126.com
Received: September 18, 2023
Peer-review started: September 18, 2023
First decision: November 1, 2023
Revised: November 11, 2023
Accepted: November 26, 2023
Article in press: November 26, 2023
Published online: December 27, 2023
Abstract
BACKGROUND

Gastric ectopic pancreas (GEP) is a rare developmental abnormality that refers to the existence of pancreatic tissue in the stomach with no anatomical relationship with the main pancreas. It is usually difficult to diagnose through histological examination, and the choice of treatment method is crucial.

AIM

To describe the endoscopic ultrasound characteristics of GEP and evaluate the value of laparoscopic resection (LR) and endoscopic submucosal dissection (ESD).

METHODS

Forty-nine patients with GEP who underwent ESD and LR in the Second Affiliated Hospital of Fujian Medical University from May 2018 to July 2023 were retrospectively included. Data on clinical characteristics, endoscopic ultrasonography (EUS), ESD, and LR were collected and analyzed. The characteristics of EUS and the efficacy of the two treatments were analyzed.

RESULTS

The average age of the patients was 43.31 ± 13.50 years, and the average maximum diameter of the lesions was 1.55 ± 0.70 cm. The lesion originated from the mucosa in one patient (2.04%), from the submucosa in 42 patients (85.71%), and from the muscularis propria in 6 patients (12.25%). Twenty-nine patients (59.20%) with GEP showed umbilical depression on endoscopy. The most common initial symptom of GEP was abdominal pain (40.82%). Tumor markers, including carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA-19-9), were generally within the normal range. One patient (2.04%) with GEP had increased CEA and CA-19-9 levels. However, no cancer tissue was found on postoperative pathological examination, and tumor markers returned to normal levels after resecting the lesion. There was no significant difference in surgery duration (72.42 ± 23.84 vs 74.17 ± 12.81 min) or hospital stay (3.70 ± 0.91 vs 3.83 ± 0.75 d) between the two methods. LR was more often used for patients with larger tumors and deeper origins. The amount of bleeding was significantly higher in LR than in ESD (11.28 ± 16.87 vs 16.67 ± 8.76 mL, P < 0.05). Surgery was associated with complete resection of the lesion without any serious complications; there were no cases of recurrence during the follow-up period.

CONCLUSION

GEP has unique characteristics in EUS. LR and ESD seem to be good choices for treating GEP. LR is better for large GEP with a deep origin. However, due to the rarity of GEP, multicenter large-scale studies are needed to describe its characteristics and evaluate the safety of LR and ESD.

Keywords: Ectopic pancreas, Endoscopic ultrasonography, Endoscopic submucosal dissection, Laparoscopic resection

Core Tip: Gastric ectopic pancreas (GEP) is a rare disease. At present, the study on GEP is mostly limited to case reports. Endoscopic ultrasonography (EUS) is the main examination method for the diagnosis of GEP. We summarized the characteristics of GEP under EUS and compared the advantages and disadvantages of laparoscopic resection and endoscopic submucosal dissection in the treatment of GEP. Both methods are safe and feasible. Due to the low incidence of this disease, we look forward to multicenter studies with large sample sizes.