St. Luke's University Health Network Bethlehem, PA, United States
Janak Bahirwani, MD1, Rodrigo Duarte-Chavez, MD1, Hussam Tayel, MD1, Aumi Brahmbhatt, MD2, Liyan Xu, MD1, Kimberly Chaput, DO3 1St. Luke's University Health Network, Bethlehem, PA; 2St. Luke's University Health Network, Easton, PA; 3St. Luke's University Health Network, Fountain Hill, PA
Introduction: Pancreatic rest (PR) or ectopic pancreas can be found virtually anywhere in the gastrointestinal tract. It has a prevalence of 0.55-14%. It is a congenital abnormality arising during rotation of the foregut. It is most commonly found in the stomach and duodenum. Pancreatic rest of the esophagus has been reported but is rare.
Case Description/Methods: A 60-year-old male presented with intermittent heartburn and dysphagia. He denied any weight loss, melena, nausea or vomiting. His labs were within normal limits. Given his age and symptoms he was scheduled for an esophagogastroduodenoscopy (EGD). The EGD showed Class A Esophagitis and multiple small clean based ulcers in the stomach. Biopsies showed gastritis and were negative for H.pylori. He had been using ibuprofen since a few months prior to his EGD for arthritis of his hands. He was advised to stop that and was started on a proton pump inhibitor (PPI). He was scheduled for a repeat EGD in 8 weeks which showed no ulcers but did show one island of pink mucosa just proximal to the gastro-esophageal junction (GEJ) at 38 cm. (GEJ was at 40 cm) This was suspicious for Barrett’s and hence was biopsied. The biopsy showed squamo-columnar junction mucosa with focal pancreatic acinar metaplasia/heterotopia suggestive of ectopic pancreatic tissue. No dysplasia or evidence of malignancy was seen. His symptoms responded to PPI therapy. He will be monitored closely for the development of any upper GI symptoms and will need endoscopic surveillance if he does develop any symptoms in the future.
Discussion: PR may easily be overlooked. Even with better diagnostic tools and techniques, it can be missed because it is usually asymptomatic. Most often, it presents as a sub-epithelial nodule/lesion. However, in our patient it had the appearance of Barrett’s esophagus. Complications, when they do arise can be similar to the pancreas and include acute or chronic pancreatitis, pseudocyst formation, pancreatic intraepithelial neoplasia and carcinoma. Because of the risk of carcinoma, it is important to detect these lesions. The management of PR is unclear. It has been suggested that asymptomatic lesions and lesions less than 2 cm can be monitored clinically or with routine endoscopic surveillance. Lesions greater than 3 cm or if symptomatic should be resected with Endoscopic mucosal resection. In our patient, given the small patch of mucosal abnormality, we decided to monitor him clinically and plan for repeat endoscopy if he does develop any symptoms in the future.
Figure: A- EGD showing salmon-pink colored mucosa just proximal to the GEJ B- Histology demonstrates pancreatic acinar metaplasia/heterotopia at the GEJ
Janak Bahirwani indicated no relevant financial relationships.
Rodrigo Duarte-Chavez indicated no relevant financial relationships.
Hussam Tayel indicated no relevant financial relationships.
Aumi Brahmbhatt indicated no relevant financial relationships.
Liyan Xu indicated no relevant financial relationships.
Kimberly Chaput indicated no relevant financial relationships.
Janak Bahirwani, MD1, Rodrigo Duarte-Chavez, MD1, Hussam Tayel, MD1, Aumi Brahmbhatt, MD2, Liyan Xu, MD1, Kimberly Chaput, DO3. P0051 - Pancreatic Rest of the Esophagus Mimicking Barrett’s: A Case Report, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.