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Gastric heterotopic pancreas in children: A prospective endoscopic study
Kate Seddon1, Mark D Stringer1
1Department of Paediatric Surgery, Wellington Children's Hospital and Department of Paediatrics and Child Health, Wellington School of Medicine, University of Otago, New Zealand.
Insights
Gastric heterotopic pancreas (HP) appears in about 1% of pediatric upper GI endoscopies. This condition is more common in children with esophageal atresia (EA) and may be linked to trisomy 21.
Area of Science:
- Pediatric Gastroenterology
- Endoscopic Diagnostics
- Congenital Anomalies
Background:
- Heterotopic pancreas (HP) is a congenital anomaly where pancreatic tissue is found outside its normal location.
- Gastric HP is a rare form of HP, and its prevalence and endoscopic appearance in children are not well-documented.
Purpose of the Study:
- To determine the prevalence of gastric heterotopic pancreas (HP) in children undergoing upper gastrointestinal (GI) endoscopy.
- To describe the characteristic endoscopic appearance of gastric HP in the pediatric population.
Main Methods:
- Prospective study over 4 years involving pediatric patients undergoing flexible upper GI endoscopy.
- Analysis of endoscopic findings in 607 procedures performed on 478 children.
- Correlation of gastric HP presence with patient history, including esophageal atresia (EA) and trisomy 21.
Main Results:
- Gastric HP was identified in 11 children (1.8% prevalence).
- Lesions typically presented as 1-2 cm umbilicated submucosal nodules in the gastric antrum.
- Prevalence was higher in children with repaired esophageal atresia (5/13) and trisomy 21 (2/9).
- The prevalence in children without EA or trisomy 21 was 1.1%.
Conclusions:
- Gastric HP is found in approximately 1% of pediatric upper GI endoscopies.
- Gastric HP is significantly more prevalent in children with EA and potentially associated with trisomy 21.
- Recognizing the typical endoscopic appearance of gastric HP is crucial to prevent misdiagnosis and ensure appropriate patient management.
Purpose:
To document the prevalence and variable appearance of gastric heterotopic pancreas (HP) in children undergoing upper gastrointestinal (GI) endoscopy.
Methods:
A prospective 4-year study of children undergoing flexible upper GI endoscopy in a single institution.
Results:
A total of 607 upper GI endoscopies were performed in 478 pediatric patients during the 4-year period. Eleven children (6 girls, 5 boys) aged 2.9 to 16.9 years had endoscopic features typical of gastric HP. All but one lesion was located in the gastric antrum and most appeared as an umbilicated submucosal nodule measuring 1-2 cm in diameter. Five of 13 children with repaired esophageal atresia (EA) and two of nine children with trisomy 21 had gastric HP. The prevalence of endoscopically visualized gastric HP in children without a history of EA or trisomy 21 was 1.1%.
Conclusions:
Gastric HP is present in about 1% of pediatric upper GI endoscopies. It is significantly more common in patients with EA and may also be associated with trisomy 21. Gastric HP typically appears as a single 1-2 cm antral submucosal nodule, usually with a central pit. Recognition of this lesion is important to avoid misdiagnosis and inappropriate treatment.
Level Of Evidence:
Level II (diagnostic).
