Clinical Endoscopy

A Rare Case of Early Gastric Cancer Combined with Underlying Heterotopic Pancreas: Jung Bin Yoon, Bong Eun Lee, Dae Hwan Kim, Do Youn Park, Hye Kyung Jeon, Dong Hoon Baek, Gwang Ha Kim, Geun Am Song; Clin Endosc 2018;51(2):192-195. Published online August 31, 2017; DOI: https://doi.org/10.5946/ce.2017.055

Heterotopic pancreas in the stomach is usually asymptomatic and benign. Here, we presented a rare case of an early gastric cancer overlying a heterotopic pancreas. A 48-year-old woman underwent esophagogastroduodenoscopy, which revealed a subepithelial mass measuring 2.0×1.5 cm on the gastric antrum with a 1-cm erosive erythematous discoloration on the surface. A biopsy specimen showed moderately differentiated tubular adenocarcinoma. Endosonography showed a heterogeneous hypoechoic mass measuring 1.3×0.6 cm, with indistinct margins in the second and third layers of the gastric wall; anechoic tubular structures within the mass were suggestive of heterotopic pancreas. Distal gastrectomy was performed, which confirmed an early gastric cancer confined to the mucosa, and a separate underlying heterotopic pancreas. Although heterotopic pancreas is most likely benign, careful endoscopic observation of the mucosal surface is necessary to avoid overlooking a coincident early gastric cancer.

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Duodenal Heterotopic Pancreas with a Large Retention Cyst: A Case Report and Literature Review
Shinya Kawaguchi, Akinori Murakami, Masato Nishida
Internal Medicine.2023; 62(5): 723. CrossRef
Gastric ectopic pancreas combined with synchronous multiple early gastric cancer: A rare case report
Zhen-Ya Zhao, Yue-Xing Lai, Ping Xu
World Journal of Clinical Cases.2023; 11(7): 1569. CrossRef
A rare case of enlarged gastric heterotopic pancreas with retention cysts: A case report and literature review
Keiso Matsubara, Michihiro Ishida, Toshiaki Morito, Tetsushi Kubota, Yasuhiro Choda, Masao Harano, Hiroyoshi Matsukawa, Hitoshi Idani, Shigehiro Shiozaki, Masazumi Okajima
International Journal of Surgery Case Reports.2020; 74: 284. CrossRef
A case of gastric heterotopic pancreas with gastroduodenal invagination
Shoko Iwahashi, Masaaki Nishi, Toshiaki Yoshimoto, Hideya Kashihara, Chie Takasu, Takuya Tokunaga, Tomohiko Miyatani, Jun Higashijima, Kozo Yoshikawa, Yuma Wada, Yoshimi Bando, Mitsuo Shimada
Surgical Case Reports.2019;[Epub] CrossRef

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Acute Ectopic Pancreatitis Occurring after Endoscopic Biopsy in a Gastric Ectopic Pancreas: Seong Jun Lee, Gwang Ha Kim, Do Youn Park, Sang A Choi, Sang Hee Lee, Yu Yi Choi, Moo Song Jeon, Geun Am Song; Clin Endosc 2014;47(5):455-459. Published online September 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.5.455

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Ectopic pancreas is a congenital anomaly and the most common type of ectopic tissue in the gastrointestinal tract. Most patients with an ectopic pancreas are asymptomatic and rarely have complications. Ectopic pancreatitis after an endoscopic biopsy has not been reported. We report a patient who developed acute ectopic pancreatitis in the stomach after an endoscopic biopsy. A 71-year-old male patient presented with a subepithelial tumor (SET) in the stomach and had no symptoms. Endoscopic ultrasonography demonstrated a 30-mm hypoechoic mural mass, lobulated margins, and anechoic duct-like lesions. To obtain proper tissue specimen, endoscopic biopsy was performed through the opening on the surface of the mass. The pathologic results confirmed an ectopic pancreas. One day after the endoscopic biopsy, he developed persistent epigastric pain. His serum amylase and lipase elevated. Computed tomography of the abdomen showed swelling of the SET and diffuse edema of the gastric wall. His condition was diagnosed as acute ectopic pancreatitis occurring after endoscopic biopsy.

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Gastric outlet obstruction associated with gastric ectopic pancreas in children: Report of two cases
Chia-Wei Liu, Hsun-Chin Chao, Wan-Hsin Su
Pediatrics & Neonatology.2025; 66(1): 78. CrossRef
Gastric ectopic pancreas in magnetic resonance imaging: A review of 2 cases
Miguel Braga, António P. Matos, Pedro Pinto Marques, Miguel Ramalho
Radiology Case Reports.2023; 18(3): 1181. CrossRef
Clinicopathological features and management strategy for superficial nonampullary duodenal tumors: a multi-center retrospective study
Eun Young Kim, Dong Jin Kim, Han Hong Lee, Jun Hyun Lee, Jeong Goo Kim, Kyo Young Song, Jin Jo Kim, Hyung Min Chin, Wook Kim
Annals of Surgical Treatment and Research.2022; 102(5): 263. CrossRef
Pancreatitis in the developmentally anomalous pancreas
Cecil G. Wood, Camila Lopes Vendrami, Elizabeth Craig, Pardeep K. Mittal, Frank H. Miller
Abdominal Radiology.2020; 45(5): 1316. CrossRef
Minimally Invasive Management of Ectopic Pancreas
Gerardo A. Vitiello, Michael J. Cavnar, Cristina Hajdu, Inessa Khaykis, Elliot Newman, Marcovalerio Melis, H. Leon Pachter, Steven M. Cohen
Journal of Laparoendoscopic & Advanced Surgical Techniques.2017; 27(3): 277. CrossRef
Clinical picture: multiple sites of ectopic pancreatic tissue
J Straatman, R J Meester, N C T v. Grieken, M J A M Jacobs, P d. Graaf, G Kazemier, M A Cuesta
SpringerPlus.2015;[Epub] CrossRef

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Ectopic Pancreas Bleeding in the Jejunum Revealed by Capsule Endoscopy: Mi-Jeong Lee, Jae Hyuck Chang, Il Ho Maeng, Jin Young Park, Yun Sun Im, Tae Ho Kim, Sok-Won Han, Do Sang Lee; Clin Endosc 2012;45(3):194-197. Published online August 22, 2012; DOI: https://doi.org/10.5946/ce.2012.45.3.194

Abstract PDF PubReader ePub

Ectopic pancreas is defined as pancreatic tissue found outside the usual anatomic location. It is often found incidentally at different sites in the gastrointestinal (GI) tract. The incidence of ectopic pancreatic tissue in autopsy series is 1% to 2%, with 70% of the ectopic lesions found in the stomach, duodenum and jejunum. Although it is usually a silent anomaly, an ectopic pancreas may become clinically evident when complicated by inflammation, bleeding, obstruction or malignant transformation. We report a case of ectopic pancreas located in the jejunum and presenting as an obscure GI bleeding, which was diagnosed by capsule endoscopy.

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Various Phenotypes of Ectopic Pancreatic Tissue in Children: Case Series and Literature Review
Elena Roxana Matran, Andra-Mihaela Diaconu, Oana Neagu, Alexandru-Ioan Ulmeanu
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Clinical features and treatment of heterotopic pancreas in children: a multi-center retrospective study
Xiaofeng Yang, Chen Liu, Shuai Sun, Chao Dong, Shanshan Zhao, Zaitun M. Bokhary, Na Liu, Jinghua Wu, Guojian Ding, Shisong Zhang, Lei Geng, Hongzhen Liu, Tingliang Fu, Xiangqian Gao, Qiong Niu
Pediatric Surgery International.2024;[Epub] CrossRef
Gastric Ectopic Pancreas With Pseudocyst Formation Causing Gastric Outlet Obstruction
Austin Dickerson, Aran Farrell, Abida Bushra, Scott Celinski, Vani J.A. Konda, Hemangi Kale, Anh D. Nguyen
ACG Case Reports Journal.2023; 10(2): e00988. CrossRef
The Diagnosis of Small Gastrointestinal Subepithelial Lesions by Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy
Masanari Sekine, Takeharu Asano, Hirosato Mashima
Diagnostics.2022; 12(4): 810. CrossRef
A modern view at the treatment of ectopic pancreas in the gastro-duodenal zone in children (a literature review)
G. N. Rumyantseva, E. I. Kazakova, Yu. F. Brevdo, A. N. Kazakov
Russian Journal of Pediatric Surgery.2022; 26(1): 18. CrossRef
Unusual Cause of GI Bleed—Ectopic Pancreas
Sivarahini Ganesan, Kannan Devy Gounder, Anbalagan Pichaimuthu
Indian Journal of Surgery.2021; 83(6): 1584. CrossRef
Role of Video Capsule in Small Bowel Bleeding
Richard M. Wu, Laurel R. Fisher
Gastrointestinal Endoscopy Clinics of North America.2021; 31(2): 277. CrossRef
Heterotopic pancreas adenocarcinoma in the stomach: A case report and literature review
Yao Xiong, Yue Xie, Dan-Dan Jin, Xin-Ying Wang
World Journal of Clinical Cases.2020; 8(10): 1979. CrossRef
A case of ectopic pancreas in the ileum presenting as obscure gastrointestinal bleeding and abdominal pain
Rugile Mickuniene, Ieva Stundiene, Tomas Jucaitis, Dileta Valanciene, Jonas Valantinas
BMC Gastroenterology.2019;[Epub] CrossRef
Endoscopic ultrasonography diagnosis of subepithelial lesions
Mitsuhiro Kida, Yusuke Kawaguchi, Eiji Miyata, Rikiya Hasegawa, Toru Kaneko, Hiroshi Yamauchi, Shuko Koizumi, Kosuke Okuwaki, Shiro Miyazawa, Tomohisa Iwai, Hidehiko Kikuchi, Maya Watanabe, Hiroshi Imaizumi, Wasaburo Koizumi
Digestive Endoscopy.2017; 29(4): 431. CrossRef
The Role of Laparoscopy in the Management of a Diagnostic Dilemma: Jejunal Ectopic Pancreas Developing into Jejunojejunal Intussusception
Alessio Giordano, Giovanni Alemanno, Carlo Bergamini, Paolo Prosperi, Alessandro Bruscino, Andrea Valeri
Case Reports in Surgery.2017; 2017: 1. CrossRef
Hepatoid adenocarcinoma arising from heterotopic pancreas of the ileum
Ling Tong, Huaxiong Pan, Jun He, Mixia Weng, Liduan Zheng
Medicine.2016; 95(33): e4067. CrossRef
Asymptomatic heterotopic pancreas in Meckel’s diverticulum: a case report and review of the literature
Alfredas Kilius, Narimantas Evaldas Samalavicius, Donatas Danys, Gytis Zaldokas, Dmitrij Seinin
Journal of Medical Case Reports.2015;[Epub] CrossRef
Endosonographic Features of Histologically Proven Gastric Ectopic Pancreas
Jen-Wei Chou, Ken-Sheng Cheng, Chun-Fu Ting, Chun-Lung Feng, Yu-Ta Lin, Wen-Hsin Huang
Gastroenterology Research and Practice.2014; 2014: 1. CrossRef
Endoscopic ultrasonography appearance of pancreatic rest
Hideki Kumagai, Koji Yokoyama, Wakamichi Shimamura, Yoshimasa Miura, Takanori Yamagata
Pediatrics International.2014; 56(4): 654. CrossRef

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Two Cases of Endoscopic Resection of Submucosal Tumor of the Minor Papilla: Yong Ho Choi, M.D., Do Hyun Park, M.D., Seong Jun Kim, M.D., Meong Jin Kang, M.D., Hyun Deuk Jo, M.D.*, Mee Hye Oh, M.D.*, Jeong Hoon Park, M.D., Suck Ho Lee, M.D., Hong Soo Kim, M.D., Sang Heum Park, M.D. and Sun Joo Kim, M.D.; Korean J Gastrointest Endosc 2007;34(3):164-169. Published online March 30, 2007

Abstract PDF: Tumors of the minor papilla are very rare and these tumors have generally been known as neuroendocrine tumors such as carcinoid tumor and somatostatinoma. As these are mostly submucosal tumors, their diagnosis is difficult by just performing endoscopic forceps biopsy, but diagnosis is possible by surgery or endoscopic resection. EUS and ERCP is an essential tool for the diagnosis of these tumors, and abdominal CT or MRI is also useful because there is the possibility of malignant tumors such as carcinoid tumor. For our present two cases, screening endoscopy revealed the polypoid lesion of the minor papilla. EUS disclosed that the submucosal tumor was limited to the submucosal layer and no abnormality was found from the abdominal CT and ERCP. Herein, we performed endoscopic resection for making the diagnosis and treatment. Histologically, these 2 tumors were diagnosed as ectopic pancreas and gangliocytic paraganglioma, respectively. (Korean J Gastrointest Endosc 2007;34:164-169)

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A Case of Gastric Ectopic Pancreas Complicated by Chronic Pancreatitis: Seung Hyun Jung, M.D., Euyi Hyeog Im, M.D., Yong Moon Kim, M.D., Sun Moon Kim, M.D., Tae Hee Lee, M.D., Kyu Chan Huh, M.D., Young Woo Choi, M.D., Young Woo Kang, M.D., Hyoun Sik Min, M.D.* and Beom Kyoung Kim, M.D.^†; Korean J Gastrointest Endosc 2006;32(6):409-412. Published online June 30, 2006

Abstract PDF: An ectopic pancreas is defined as the presence of pancreatic tissue lacking the anatomical and vascular continuity of the main body of the pancreas. Most cases of ectopic pancreas are found incidentally in the stomach and duodenum. The most commonly reported symptoms are abdominal pain, epigastric discomfort, nausea, vomiting and bleeding. An ectopic pancreas is subject to various pathological changes occurring in the pancreas itself: namely, cyst, pancreatitis, hemorrhage, necrosis and neoplastic changes. We report a case of a 28-year old man with epigastric pain in whom the surgical pathological diagnosis was an ectopic pancreas of the stomach with chronic inflammation. (Korean J Gastrointest Endosc 2006;32:409⁣413)

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Upper Gastrointestinal Bleeding Due to Gastric Ectopic Pancreas in a Young Aged Person: Jung Won Yun, M.D., Young Bum Park, M.D., Um Seok Lee, M.D., Choong Hyeon Lee, M.D., Dal Yeon Won, M.D.*, Ji Hoon Kim, M.D.^† and Jae Min Song, M.D.^‡; Korean J Gastrointest Endosc 2006;32(2):132-135. Published online February 27, 2006

Abstract PDF: An ectopic pancreas is the presence of pancreatic tissue outside of its usual location. This condition rarely causes clinical symptoms, and the most commonly reported sites of these lesions are the stomach, the duodenum and jejunum. The presence of this ectopic tissue is not a rare condition, but its unusual locations, clinical symptoms, and complications are of clinical interest. We report a case of a gastric ectopic pancreas with recurrent upper gastrointestinal bleeding in a 20-year-old man. (Korean J Gastrointest Endosc 2006;32:132⁣135)

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A Case of Gastric Ectopic Pancreas Complicated by Pancreatitis and Pseudocyst Formation: Joon Ho Wang, M.D., Jae Dong Lee, M.D., Chong Ju Kim, M.D., Hyung Seok Park, M.D., Chun Jo Jin, M.D., Mun Su Kang, M.D.*, Hi Young Sin, M.D., Keung Bin No, M.D., Keung Sub Song, M.D. and Hwa Suk Jung, M.D.; Korean J Gastrointest Endosc 2003;27(3):175-179. Published online September 30, 2003

Abstract PDF: Ectopic pancreas rarely produces clinical symptoms. Most commonly reported symptoms were abdominal pain, epigastric discomfort, nausea, vomiting, and bleeding. However, presentation of specific symptoms due to its size and location, including obstructive jaundice, and pyloric obstruction are possible. Ectopic pancreas is subject to various pathological changes occurring in the pancreas itself; namely, cyst, pancreatitis, hemorrhage, necrosis, and neoplastic change. We present a case of 60-year old woman with right upper quadrant pain in whom the surgical pathologic diagnosis was ectopic pancreas of the stomach complicated by pancreatitis and pseudocyst formation.

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위 이소성 췌장의 내시경적 소견 ( Endoscopic Findings of Ectopic Pancreas in the Stomach ): Korean J Gastrointest Endosc 1999;19(5):739-746. Published online November 30, 1998

Abstract PDF: Backgound/Aims: Ectopic pancreas in the stomach is a relatively uncommon abnormality. Although its typical finding on endoscopy was described as a submucosal nodule with central umbilication, it is still difficult to differenciate ectopic pancreas from other pathologies. So we investigated the endoscopic findings of ectopic pancreas in the stomach. Methods: Between Jan. 1987 and Aug. 1998, nineteen patients who underwent gastroendoscopy and were histologically diagnosed as ectopic pancreas by various methods, were encountered at the Department of Internal Medicine, Severance Hospital, Yonsei University. The clinicopathologic records of all the patients were reviewed. Results: The mean age of the patients was 39.3 years old with a male to female ratio of 1：2.8. Endoscopically, seventeen cases (89.5%) were suggestive of submucosal tumors. Submucosal tumors combined with umbilication were in 4 cases (21.1%), with ulceration in 2 cases (10.5%), erosion in 5 cases (26.3%), ulceration and erosion in 1 case (5.3%), and normal mucosa in 5 cases (26.3%) respectively. The size of ectopic pancreas was in the range of 0.8∼3.0 cm, except in one case which measured 6.0 cm. The location of ectopic pancreas was in the antrum in 18 cases (94.7%), and in the angle in 1 case (5.3%). The endoscopic diagnoses were ectopic pancreas in 5 cases (26.3%), submucosal tumor in 12 cases (63.1%), gastric polyp in 2 cases (10.5%). The methods of histologic diagnosis of ectopic pancreas in 3 cases (15.8%) was by endoscopic biopsy, by endoscopic submucosal resection in 10 cases (52.6%), and by operation in 6 cases (31.6%). Conclusions: Ectopic pancreas in the stomach is found in various morphology, presented as submucosal tumors in the antrum. Because histological diagnosis by endoscopic forcep biopsy is difficult in many cases, endoscopic submucosal resection or operation should be considered. (Korean J Gastrointest Endosc 19: 739∼746, 1999)

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증례 : 식도 위장관 ; 대량출혈을 동반한 십이지장 이소성 췌장 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Ectopic Pancreas of the Duodenum with Massive upper Gastrointestinal Bleeding ): Korean J Gastrointest Endosc 1997;17(2):195-199. Published online November 30, 1996

Abstract PDF: Ectopic pancreas is commonly located at stomach, duodenum and jejunum. It is a relatively rare entity and is usually of no clinical importance which especially is a very rare source of massive upper gastrointestinal bleeding. We have recently experienced a case of an ectopic pancreas in the second portion of the duodenum which was proven to be a source of massive gastrointestinal bleeding by duodenoscopy and was confirmed by surgical exploration. (Korean J Gastrointest Endosc 17: 195-199, 1997)

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