Khyber Medical College & Advocate Health Aurora St. Luke’s Medical Center Milwaukee, WI
Mohammad Aasim Khan, MBBS1, Kazi Khan, MD2, Sahibzada Usman Latif, MD, FACG3, Nilay Kumar, MD2, Ismail Ahmad, MD4 1Khyber Medical College & Advocate Health Aurora St. Luke’s Medical Center, Milwaukee, WI; 2Saint Luke's Hospital, Milwaukee, WI; 3Advocate Health Aurora Saint Luke's Hospital, Milwaukee, WI; 4Ross University School of Medicine, Milwaukee, WI
Introduction: Heterotopic pancreatic tissue is commonly found in the gastrointestinal tract, often without clinical manifestations. Malignant transformation is rare but possible. We present a case of incidental gastric antral pancreatic rest discovered during an Esophagogastroduodenoscopy (EGD). After a nonprogressive course over 8 years, the patient underwent an elective Endoscopic Full-Thickness Resection (EFTR) with no complications. Histological examination revealed a curative resection of low-grade pancreatic intraepithelial neoplasia (PanIN). This case emphasizes the role of EFTR as a diagnostic and therapeutic approach for submucosal enteral lesions.
Pancreatic Heterotopia (PH) is a congenital anomaly characterized by the presence of pancreatic tissue at extrapancreatic sites. The gastric antrum is the most common ectopic location. Malignant transformation of PH is rare, and its management usually involves surveillance. Endoscopic techniques, such as EFTR, have emerged as alternative interventions for tissue resection, particularly in patients with high surgical risk. We present a case of benign-appearing PH with hidden PanIN, managed by EFTR after a decade of surveillance
Case Description/Methods: A 61-year-old female with a history of anxiety and gastroesophageal reflux disease (GERD) underwent an EGD in 2004, revealing a 2.6cm intraluminal submucosal mass in the gastric antrum. Biopsies confirmed pancreatic rest. Surveillance over 8 years showed no changes in the mass. The patient opted for EFTR as a diagnostic and therapeutic intervention. The procedure was successfully performed using an Endoscopic Full-Thickness Resection Device, with negative margins and no postoperative complications. Pathology revealed low-grade PanIN within the pancreatic rest
Discussion: PH is a rare congenital anomaly, often incidentally found during abdominal surgeries or gastrostomies. Its malignant transformation is infrequent, and the management of asymptomatic PH is not well-established. However, our case highlights the neoplastic potential of PH, regardless of gross or imaging characteristics. Surveillance is the standard of care, but EFTR offers a definitive management option with shorter procedure time and a lower risk profile. EFTR is safer and effective for gastrointestinal submucosal tumors, providing curative resections without the complications associated with surgery.
Figure: Image A; Incidental Pancreatic Heterotopic Submucosal Mass measuring 2.6cm in length 0.5cm in width Image B; EFTR’s use of making a Resection margin around the mass which is to be removed through the entire wall of the gut Image C; Full thickness Resection device with a snare and a clip present on the inside of the device that is connected to the top of the endoscope. Image D; Revealing the imminent resection of the mass throughout the entire gut wall from Mucosal layer, to Submucosal layer to the muscularis layer and leaving only the adipose tissue remaining intact, which is approximated by the clip of the device being used Image E; The EFTR specimen measured 2.6 x 2.1 x 0.2 cm in size. The specimen was intact, and the vertical and lateral margins were uninvolved confirming a R0 and curative resection.
Disclosures:
Mohammad Aasim Khan indicated no relevant financial relationships.
Kazi Khan indicated no relevant financial relationships.
Sahibzada Usman Latif indicated no relevant financial relationships.
Nilay Kumar indicated no relevant financial relationships.
Ismail Ahmad indicated no relevant financial relationships.
Mohammad Aasim Khan, MBBS1, Kazi Khan, MD2, Sahibzada Usman Latif, MD, FACG3, Nilay Kumar, MD2, Ismail Ahmad, MD4. P2324 - Endoscopic Full-Thickness Resection as a Diagnostic and Therapeutic Modality for Pancreatic Heterotopia: A Case Report, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
