A Case of Multiple Metastases in the Gastric Wall Due to Needle Tract Seeding after Endoscopic Ultrasound-Guided Tissue Acquisition for Pancreatic Tail Cancer

INTRODUCTION: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is widely used for the diagnosis of pancreatic cancer, other pancreatic tumors, and autoimmune pancreatitis. Among the adverse events, needle tract seeding (NTS) is the most concerning. NTS is a phenomenon in which tumor cells are observed at the site of biopsy needle passage. We herein report a case of multiple gastric wall recurrences resulting from NTS after laparoscopic distal pancreatectomy for pancreatic tail cancer. CASE PRESENTATION: A 71-year-old woman was diagnosed with pancreatic tail adenocarcinoma using EUS-TA and underwent laparoscopic distal pancreatectomy following neoadjuvant chemotherapy. Three and a half years postoperatively, two submucosal gastric lesions were identified and histologically confirmed as NTS. Since there was no recurrence at any site other than the site of NTS on close examination, a total gastrectomy was performed with postoperative adjuvant chemotherapy, and the patient remained recurrence-free. CONCLUSIONS: We report a case of multiple synchronous NTS after EUS-TA. EUS-TA is a very useful examination method for pancreatic tumors; however, it should be performed with particular care in cases of invasive pancreatic ductal carcinoma after distal pancreatectomy. If NTS in the gastric wall is detected at an early stage, surgical resection is possible and the patient prognosis can be improved.