上消化道异位胰腺的内镜诊断和治疗

Diagnosis and treatment of upper gastrointestinal heterotopic pancreas under endoscopies

目的总结上消化道异位胰腺的内镜诊断经验，以引起对该疾病的重视，减少漏诊和误诊。方法内镜检查发现上消化道黏膜下隆起，表面光滑、糜烂或溃疡，行黏膜活检病理或内镜下黏膜切除术（EMR）。结果11例病人中，胃窦异位胰腺8例，十二指肠3例。内镜诊断：5例诊断为异位胰腺，4例诊断为黏膜隆起性质待定，1例诊断为胃息肉，1例诊断为胃平滑肌肉瘤，重复活检，1例诊断为恶性肿瘤，外科手术切除，11例病人活检或手术病理均为异位胰腺。结论部分异位胰腺可有典型的内镜下特征，但其余一部分呈多样性，与息肉、平滑肌瘤、平滑肌肉瘤等难以鉴别，需依赖黏膜活检病理诊断。内镜超声显示病灶仅限于黏膜下层未达肌层者，行内镜下黏膜切除术安全有效。

AIM To summarize our experience in diagnosing and treating heterotopic pancreas under endoscopies, for better understanding and reducing missed or fault diagnosis of this rare disease. METHODS The lesions were Biopsied or removede by EMR under endoscopies when they such as smooth, erosive or ulcerative protrusions are found in the upper gastrointestinal tract. RESULTS In 11 cases studied, 8 are gastric heterotopic pancreata, 3 duodenal heterotopic pancreata. Endoscopic diagnosis： 5 heterotopic pancreata,4 mucosal protrusions with undefined nature, 1 gastric polyp, 1 gastric leiomysarcoma , 1 malignancy which was surgically removed. All cases are confirmed as heterotopic pancreata by pathological diagnosis. CONCLUSION Some heterotopic pancreata has typical appearences under end oscopies, but others are hard to differentiate from polyp, leiomyoma or leiomyosarcoma, whose diagnosis should be based on pathological results. The foci, which is restricted within submucosa and without any sign of infiltration under ultrasonic endoscope, can be safely removed by EMR.