Ectopic pancreas

Pancreas tissue not connected to pancreas for blood supply or anatomical structure

Most prevalent in stomach; commonly within 6cm of pylorus on greater curve

Incidence of 0.5 – 13% on autopsies

Investigation:

OGD

EUS + FNA can be diagnostic if required (pancreas will be within submucosa or intrinsic muscle layer)

Treatment:

– Recently, endoscopic treatment is preferred if possible – ESD, STER (submucosal tunnel endoscopic resection) etc..

– Sometimes ligation alone will suffice

– If growth has gone through entire wal of the organ, then local excision is needed.

– If any possibility of cancer, then aggressive surgical resection is necessary

– If symptomatic, then treatment is essential

– If asymptomatic, (Am J Gastro; 2023)

o Most experts would diagnose with EUS +FNA and once confirmed, no further follow-up necessary (58%), independent of size

o 38% would follow-uop if >20mm, 2-yearly OGD (stop if appearance is stable)

o If no histological diagnoses, repeat EUS as follow-up (48%)

o If >50% change in size, opt for resection (EMR/ESD/Surgical)