Department of Medicine, Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY, 11794, USA.
Department of Surgery, University of Pittsburgh Medical Center Pinnacle, 4300 Londonderry Road, Harrisburg, PA, 17109, USA.
Surg Endosc. 2021 Feb;35(2):536-561. doi: 10.1007/s00464-020-08040-2. Epub 2020 Oct 1.
Pancreatic rest (PR) is an ectopic pancreatic lesion that is usually found incidentally on endoscopy or surgery. While most lesions do not have clinical significance, some patients are symptomatic and rarely, PR can predispose to malignancy. With the growing popularity of bariatric surgery, it has been unclear how to manage PR found on screening endoscopies, prior to bariatric surgery. Through review of the current literature, we propose an algorithm for clinicians to evaluate and manage PR found on screening endoscopies prior to bariatric surgery.
We performed a literature search in PubMed pertaining to PR, clinical characteristics, risk of malignant transformation, endoscopic characteristics, histological descriptions, and resection techniques. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), we found 33 published articles from 2001 to 2019, including case reports, case series, retrospective cohorts, and a review paper.
PR is commonly found incidentally in the gastric antrum. Larger lesions have a higher risk of being symptomatic or predisposing to malignant transformation. Endoscopic ultrasound (EUS) can assist in the diagnosis of PR and guide resection technique. Certain histological characteristics, such as Heinrich class, grading of neoplasia, and genetic alterations, can determine malignancy risk of PR. Resection technique, either endoscopically or surgically, should be based on lesion size, depth of wall invasion, and the endoscopists' level of skill in endoscopic resection.
Proper evaluation and treatment of PR should be considered because of the risk for symptoms and malignant transformation. Symptomatic lesions and those at risk for malignant transformation should be considered for resection. EUS can guide the diagnosis and type of resection, either endoscopically through EMR or ESD or surgically through sleeve gastrectomy or Roux-en-Y gastric bypass (RYGB).
胰腺静止（PR）是一种异位胰腺病变，通常在胃镜或手术时偶然发现。虽然大多数病变没有临床意义，但有些患者有症状，极少数情况下，PR 可能会导致恶性肿瘤。随着减重手术的日益普及，对于在减重手术前筛查性胃镜检查中发现的 PR，如何进行管理尚不清楚。通过对现有文献的回顾，我们提出了一种用于评估和管理在减重手术前筛查性胃镜检查中发现的 PR 的临床医生算法。
我们在 PubMed 上进行了与 PR、临床特征、恶性转化风险、内镜特征、组织学描述和切除术技术相关的文献检索。使用系统评价和荟萃分析的首选报告项目（PRISMA），我们从 2001 年至 2019 年共找到 33 篇已发表的文章，包括病例报告、病例系列、回顾性队列和一篇综述文章。
PR 通常在胃窦部偶然发现。较大的病变更有可能出现症状或导致恶性转化。内镜超声（EUS）可协助 PR 的诊断并指导切除术技术。某些组织学特征，如 Heinrich 分级、肿瘤分级和遗传改变，可确定 PR 的恶性风险。切除术技术，无论是内镜下还是手术切除，应根据病变大小、壁浸润深度以及内镜医生进行内镜下切除术的技能水平来决定。
由于有症状和恶性转化的风险，应考虑对 PR 进行适当的评估和治疗。有症状的病变和有恶性转化风险的病变应考虑进行切除。EUS 可指导诊断和切除术类型，可通过 EMR 或 ESD 进行内镜下切除，也可通过袖状胃切除术或 Roux-en-Y 胃旁路术（RYGB）进行手术切除。
