A 55-year-old gentleman presents with epigastric discomfort which he has had for 2 years. He denies tarry stools, haematemesis, dysphagia or weight loss. He has a past history of hypertension and ischaemic heart disease. He is taking aspirin and nifedipine. He has had no previous endoscopic work-up.
•Temperature 37.1°C, pulse 72 bpm, BP 135/85mmHg, SaO2 98-100% on RA.
•Hydration is satisfactory.
•Examination of the hands reveals no clubbing and normal-appearing palmar creases.
•Head and neck examination is unremarkable.
•Cardiovascular: HS dual, no murmur.
•His chest is clear on auscultation.
•Abdominal examination reveals a soft, non-tender abdomen.
•No signs of oedema.
–WBC 5.9 x 109/L;
–platelets 285 x 109/L.
What is your differential diagnosis of his epigastric discomfort?
•Peptic ulcer disease.
•Gastro-oesophageal reflux disease (GORD).
•Malignancy (e.g. liver, oesophageal, gastric).
•Pancreatic disease (chronic pancreatitis).
The endoscopic photos show an antral submucosal nodule with an umbilicated appearance. The overlying mucosa appears normal.
What is the differential diagnosis?
•Gastrointestinal stromal tumours (GISTs).
Which of the above is more likely, and why?
An ectopic pancreas.