Endoscopic submucosal dissection of pancreatic heterotopia in children.

Aberrant pancreatic tissue is mostly found in the submucosal layer of the upper gastrointestinal tract, occurring in 1.7% of the population according to summarized post-mortem studies [1]. Gastric pancreatic heterotopia was first recognized by Klob in 1859 [2]. Hereinwe describe the resection of gastric pancreatic heterotopic lesions in children by endoscopic submucosal dissection (ESD). After the lesion has been localized endoscopically (GIF-HG 290; Olympus Medical, Tokyo, Japan), its extent within the stomachwall is clarified by ultrasound (UM-2R; Olympus Medical) (●" Fig.1). A solution is circumferentially injected into the submucosa of the lesion (●" Fig.2). This solution consists of 2.5mL 1% sodium hyaluronate (Hyruan; LG Life Sciences) and 7.5mL of a mixture that is made up of 5mL adrenalin (1 :10000; DBC Adrenaline Injection) and 1–2mL of 8% indigo carmine (Indigocarmin Amino) diluted in 100mL normal saline. An electrosurgical knife (DualKnife, KD-650L; OlympusMedical) is used for the mucosal incision and submucosal dissection of the lesion (●" Fig.3). A 12-year-old girl with known hemoglobin H disease presented with intermittent epigastric pain. She was diagnosed with gallstones and a polypoid lesion in the antrum of the stomach (●" Fig.4). She underwent a laparoscopic cholecystectomy and the gastric lesion was removed by ESD Fig.2 A solution of sodium hyaluronate, adrenalin, indigo carmine, and normal saline is circumferentially injected into the submucosa of the lesion: a the start of the injection; b completion of the injection.