Journal of Gastrointestinal Surgery

, Volume 12, Issue 5, pp 877–881 | Cite as

Clinical Analysis of Ectopic Pancreas with Endoscopic Ultrasonography: An Experience in a Medical Center

  • Sheng-Hung Chen
  • Wen-Hsin Huang
  • Chun-Lung Feng
  • Jen-Wei Chou
  • Chung-Hu Hsu
  • Cheng-Yuan Peng
  • Mei-Due Yang



To describe the endosonographic features of gastrointestinal ectopic pancreas, especially when histopathological diagnosis is unachievable with nonsurgical modalities.


Endoscopic ultrasonography was performed in 20 patients with endoscopically recognized ectopic pancreas. We then analyzed the endosonographic features of the lesions and the clinical aspects of the patients, including age, gender, symptoms, and lesion locations.


Endoscopic ultrasonography revealed that the lesions originated from the second, third, and/or fourth layers of the gastrointestinal wall. Most lesions (95%, 19/20) were heterogenous, mainly hypoechoic or mixed, in echogenicity. The borders of the lesions were indistinct in 13 (13/20, 65%) and distinct in 7 (7/20, 35%) patients. Anechoic cystic or tubular structures within the lesions appeared in 7 of the 20 lesions (35%).


Ectopic pancreas usually appears as a submucosal lesion with characteristic central dimpling. Furthermore, characteristic endoscopic ultrasonographic features can readily assist in the diagnosis of ectopic pancreas without having to perform endoscopic biopsy or surgery. However, either endoscopic ultrasonography-guided fine needle aspiration or endoscopic removal of lesions should still be considered mandatory for the differential diagnosis of ectopic pancreas whenever typical endosonographic features cannot be well demonstrated.


Ectopic pancreas Aberrant pancreas Endoscopic ultrasonography 


  1. 1.
    Feldman M, Friedman LS, Brandt LJ, et al. Anatomy, histology, embriology, and developmental anomalies of the pancreas. Sleisenger & Fordtran’s gastrointestinal and liver disease, vol 1, 8th ed. Philadelphia: Saunders Elsevier, 2006, pp 1183–1184.Google Scholar
  2. 2.
    Dolan RV, ReMine WH, Dockerty MB. The fate of heterotopic pancreatic tissue. Arch Surg 1974;109:762–765.PubMedGoogle Scholar
  3. 3.
    DeBord JR, Majarakis JD, Nyhus LM. An unusual case of heterotopic pancreas of the stomach. Am J Surg 1981;141:269–273.PubMedCrossRefGoogle Scholar
  4. 4.
    Burke GW, Binder SC, Barron AM, Dratch PL, Umlas J. Heterotopic pancreas: gastric outlet obstruction secondary to pancreatitis and pancreatic pseudocyst. Am J Gastroenterol 1989;84:52–55.PubMedGoogle Scholar
  5. 5.
    Armstrong C, King P, Dixon J, Macleod I. The clinical significance of heterotopic pancreas in the gastrointestinal tract. B J Surg 1981;68:384–387.CrossRefGoogle Scholar
  6. 6.
    Yoshida T, Sakamoto A, Kuroki K, Kojo A, Watanabe H, Tanaka K. Electrocoagulation biopsy of aberrant pancreas of the stomach. Am J Gastroenterol 1976;66:554–558.PubMedGoogle Scholar
  7. 7.
    Matsushita M, Hajiro K, Okazaki K, Takakuwa H. Gastric aberrant pancreas: EUS analysis in comparison with the histology. Gastrointest Endosc 1999;49:493–497.PubMedCrossRefGoogle Scholar
  8. 8.
    Hase S, Nakazawa S, Yoshino J, Kojima Y, Niwa Y, Ohashi S. A study on gastric and small intestinal aberrant pancreas by endoscopic ultrasonography with special reference to comparison with histological appearance. Jpn J Gastroenterol 1989;86:1684–1691.Google Scholar
  9. 9.
    Geller A, Wang KK, Dimagno EP. Diagnosis of foregut duplication cysts by endoscopic ultrasonography. Gastroenterology 1995;109:838–842.PubMedCrossRefGoogle Scholar
  10. 10.
    Shen EF, Arnott IDR, Plevris J, Penman ID. Endoscopic ultrasonography in the diagnosis and management of suspected upper gastrointestinal submucosal tumors. Br J Surg 2002;89:231–235.PubMedGoogle Scholar
  11. 11.
    Rosch T, Lorenz R, Dancygier H, Wichert AV, Classen M. Endosonographic diagnosis of submucosal upper gastrointestinal tract tumors. Scand J Gastroenterol 1992;27:1–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Boyce GA, Sivak MV, Rosch T, Classen M, Fleischer DE. Evaluation of submucosal upper gastrointestinal tract lesions by endoscopic ultrasound. Gastrointest Endosc 1991;37:449–454.PubMedGoogle Scholar
  13. 13.
    Zhou PH, Yao LQ, Zhong YS, He GJ, Xu MD, Qin XY. Role of endoscopic miniprobe ultrasonography in diagnosis of submucosal tumor of large intestine. World J Gastroenterol 2004;10:2444–2446.PubMedGoogle Scholar
  14. 14.
    Perrillo RP, Zuckerman GR, Shatz BA. Aberrant pancreas and leiomyoma of the stomach: indistinguishable radiologic and endoscopic features. Gastrointest Endosc 1977;23:162–163.PubMedCrossRefGoogle Scholar
  15. 15.
    Changchien CS, Hsiaw CM, Hu TH. Endoscopic ultrasonographic classification of gastric aberrant pancreas. Chang Gung Med J 2000;23:600–607.PubMedGoogle Scholar
  16. 16.
    Kilman WJ, Berk RN. The spectrum of radiographic features of aberrant pancreatic rests involving the stomach. Radiology 1977;123:291–296.PubMedGoogle Scholar
  17. 17.
    Theoni RF, Gudgaudas RK. Ectopic pancreas: usual and unusual features. Gastrointestinal Radiol 1980;5:37–42.CrossRefGoogle Scholar
  18. 18.
    Pang LC. Pancreatic heterotopia: a reappraisal and clinicopathologic analysis of 32 cases. South Med J 1988;81:1264–1275.PubMedGoogle Scholar
  19. 19.
    Hammock L, Jorda M. Gastric endocrine pancreatic heterotopia report of a case with histologic and immunohistochemical findings and review of the literature. Arch Pathol Lab Med 2002;126:464–467.PubMedGoogle Scholar
  20. 20.
    Hideki U, Ryuichi D, Koichi H, Akiko S, Kenichiro H, Hiroshi N. Carcinoma arising from ectopic pancreas in the stomach: endoscopic detection of malignant change. J Clin Ultrasound 1998;26:265–268.CrossRefGoogle Scholar
  21. 21.
    Shaib Y, Rabaa E, Feddersen R, Jamal M, Qaseem T. Gastric outlet obstruction secondary to heterotopic pancreas in the antrum: case report and review. Gastrointest Endosc 2001;54:527–530.PubMedCrossRefGoogle Scholar
  22. 22.
    Mulholland KC, Wallace WD, Epanomeritakis E, Hall SR. Pseudocyst formation in gastric ectopic pancreas. J Pancreas (Online) 2004;5(6):498–501.Google Scholar
  23. 23.
    Vilmann P, Hancke S, Henriksen FW, Jacobsen GK. Endoscopic ultrasonography-guided fine-needle aspiration biopsy of lesions in the upper gastrointestinal tract. Gastrointest Endosc 1995;41:230–235.PubMedCrossRefGoogle Scholar
  24. 24.
    Karita M, Tada M. Endoscopic and histologic diagnosis of submucosal tumors of the gastrointestinal tract using combined strip biopsy and bite biopsy. Gastrointest Endosc 1994;40:749–753.PubMedGoogle Scholar
  25. 25.
    Lee TH, Wang HP, Lin JT. Application of endoscopic mucosal resection for diagnosis of aberrant pancreas. Gastroenterol J Taiwan 2004;21(3):215–215.Google Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2008

Authors and Affiliations

  • Sheng-Hung Chen
    • 1
  • Wen-Hsin Huang
    • 1
  • Chun-Lung Feng
    • 1
  • Jen-Wei Chou
    • 1
  • Chung-Hu Hsu
    • 1
  • Cheng-Yuan Peng
    • 1
  • Mei-Due Yang
    • 2
  1. 1.Division of Gastroenterology, Department of Internal MedicineChina Medical University HospitalTaichungRepublic of China
  2. 2.Department of SurgeryChina Medical University HospitalTaichungRepublic of China

Personalised recommendations