PMC8455212_01
ESD of pancreatic rest and EUS. (a) Visualization of umbilicated lesion and gastric outlet. (b) EUS showing the contained submucosal mass (arrow) below scope. (c) Circumferential marking of region for ESD. (d) Circumferential dissection of lifted lesion. (e) Fully resected lesion. (f) EGD of area at 11 weeks after ESD.
CRIGM2021-8853120.001.jpg
PMC8455212_01_CRIGM2021-8853120.001.jpg
fig1
Esophagogastroduodenoscopy (EGD) was performed due to persistent symptoms and a 2 cm umbilicated lesion was identified along the posterior wall of the antrum of the stomach (Figure 1(a)). EUS revealed a mixed echogenic structure enclosing an anechoic structure consistent with PR (Figure 1(b)), no signs of inflammation. The lesion was marked circumferentially with a dual knife using forced coagulation settings (Figure 1(c)). Circumferential mucosal resection was initiated at the markings using an electrosurgical knife with a dome-shaped cutting section and endocut electrocautery setting (Figure 1(d)). Submucosal tunneling was performed to complete the resection (Figure 1(e)), and minimal bleeding was controlled using soft coagulation setting. Postresection EGD at 11 weeks showed almost complete healing of the mucosa (Figure 1(f)) with normal gastric biopsies.
Hematoxylin and eosin stain showing PR: (a) PR (right) seen adjacent to gastric antral mucosa (left). (b) Pancreatic exocrine glands consistent with PR.
CRIGM2021-8853120.002.jpg
PMC8455212_01_CRIGM2021-8853120.002.jpg
fig2
Excised tissue was captured with a net retriever tool and sent to pathology, which revealed focal pancreatic heterotopia with acini, ducts, and islet cells in the subepithelium covered with distorted gastric mucosa, and thermal artifactual; there was no sign of dysplasia or inflammation (Figure 2).