胃异位胰腺的内镜诊治

Endoscopic diagnosis and treatment of gastric ectopic pancreas

目的探讨胃异位胰腺胃镜和超声内镜的表现及内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)对胃异位胰腺的疗效与安全性。方法经胃镜及超声内镜诊断为胃异位胰腺患者17例,总结其临床症状、胃镜和超声内镜下表现,将有临床症状的16例患者行ESD治疗,另1例患者随访观察。结果胃镜下多表现为隆起性病变,顶部可见导管开口呈脐样凹陷;14例患者行超声内镜检查,病灶以累及黏膜下层为主,可累及固有肌层,多数为低回声、等回声或混合回声改变;16例患者接受ESD治疗,术中发现2例患者累及固有肌层,术中、术后无出血、穿孔等并发症。术后病检提示累及固有肌层3例,随访发现1例患者病灶存在,1例未行手术患者病灶无明显变化。结论胃镜及超声内镜检查是诊断胃异位胰腺及指导治疗的重要手段。ESD可安全、有效地应用于胃异位胰腺的治疗,并发症发生率低,无症状患者可随访观察。

Objective To investigate the characteristics of gastric ectopic pancreas under gastroendoscopy and endo- scopic ultrasonography （EUS） , and to observe the efficacy and safety of endoscopic submucosal dissection （ESD） in patients with gastric ectopic pancreas. Methods Data of 17 patients with gastric ectopic pancreas diagnosed by gastro- endoscopy and EUS were collected, including clinical and endoscopic manifestations, 16 cases of clinical manifestations underwent ESD, 1 ease underwent long term follow-up. Results Most gastric ectopic pancreas patients were represen- ted with protuberant lesion and centrally umbilicated intact. Under EUS, the lesions were low, approximative or mixed echoes; mostly involved submucosa, and sometimes involved muscularis propria. Sixteen patients underwent ESD, 2 pa- tients involed muscularis propria, but no perforation or severe hemorrhage occurred, and postoperative pathological re- sults revealed that 3 patients involed muscularis propria. During followed-up, there was one relapse and the other one had no obvious change. Conclusion Gastroendoscopy and EUS are effective for diagnosis of gastric ectopic pancreas. ESD is an effective and safe endoscopic procedure to remove gastric ectopic pancreas with a lower incidence of therapeu- tic relative complication, and endoscopic surveillance is a better alternative method for the patients who have no clinical manifestations.