title: Endoscopic color doppler ultrasonography in predicting the safety of endoscopic submucosal dissection for antral heterotopic pancreas.
abstract: OBJECTIVE
  Complications are important determining factors for safety of endoscopic submucosal dissection (ESD) for gastric heterotopic pancreas (HP). This study investigated whether endoscopic color Doppler ultrasonography (ECDUS) could be used to predict the feasibility, efficacy, and safety of ESD.
  
  
  METHODS
  The study included 52 patients with heterotopic pancreas of the gastric antrum who underwent ECDUS before ESD. ECDUS was used to evaluate the submucosal vascular structure and the location of HP in gastric wall. The patients who had a vessel at least 500 μm in diameter or at least 10 vascular structures per field of view were classified into the rich group (Group R), and others were classified into the non-rich group (Group N). Procedure time, decrease in hemoglobin, frequency of clip use, complications, recurrence rate, and others were retrospectively evaluated.
  
  
  RESULTS
  There were 18 patients in Group R and 34 patients in Group N. Mean procedure time was significantly longer in group R (55.4 min) than in group N (35.5 min) (P = 0.014). The incidence of muscle injury and clip use were significantly higher in group R (77.8/83.3%) than in group N (20.6/23.5%) (P < 0.05). Mean decrease in hemoglobin was 2.5 g/dL in group R and 2.4 g/dL in group N, with no significant difference. There were no recurrences in any cases during the follow-up period.
  
  
  CONCLUSIONS
  Preoperative identification of submucosal vascular structure by ECDUS can predict procedure time and the incidence of muscle injury and clip use, which is particularly suitable for predicting ESD safety in heterotopic pancreas of stomach.
authors.affiliation: Department of Digestive Endoscopy, The First People's Hospital of Wujing District, Suzhou, China.
authors.forename: Ling
authors.initials: L
authors.lastname: Xin
authors.affiliation: Department of Gastroenterology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, China.
authors.forename: Li Qian
authors.initials: LQ
authors.lastname: Jun
authors.affiliation: Department of Digestive Endoscopy, The First People's Hospital of Wujing District, Suzhou, China.
authors.forename: Xu Li
authors.initials: XL
authors.lastname: Hua
authors.affiliation: Department of Digestive Endoscopy, The First People's Hospital of Wujing District, Suzhou, China.
authors.forename: Zhu
authors.initials: Z
authors.lastname: Hong
authors.affiliation: Department of Digestive Endoscopy, The First People's Hospital of Wujing District, Suzhou, China.
authors.forename: Chen Tian
authors.initials: CT
authors.lastname: Bao
authors.affiliation: Department of Digestive Endoscopy, The First People's Hospital of Wujing District, Suzhou, China.
authors.forename: Tang Jin
authors.initials: TJ
authors.lastname: Hai
mesh_terms: D000328:Adult; D000368:Aged; D000069916:Endoscopic Mucosal Resection / Q000009:adverse effects*; D019160:Endosonography / Q000379:methods*; D005260:Female; D005753:Gastric Mucosa / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D055815:Young Adult