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. 1978 Sep;188(3):384–393. doi: 10.1097/00000658-197809000-00014

The Zollinger-Ellison syndrome--23 years later.

C W Deveney, K S Deveney, L W Way
PMCID: PMC1396985  PMID: 686901

Abstract

The effects of recent diagnostic and therapeutic advances were assessed in 65 patients with the Zollinger-Ellison syndrome (ZES). Twenty-seven patients seen between 1955 and 1970 were compared with 38 patients seen between 1971 and 1977. The earlier patients had a higher incidence of virulent ulcer disease (56% vs. 24%), other endocrinopathies (48% vs. 13%), and malignant gastrinoma (44% vs. 25%). Earlier diagnosis is the result of liberal use of serum gastrin measurements and provocative tests for gastrin release (calcium and secretin), and an increased awareness of this syndrome. Because their basal gastrin values were in a range that overlapped ordinary ulcer disease, 47% of patients encountered in recent years required provocative testing with secretin for diagnosis. If the gastrin concentration falls to normal following resection of a gastrinoma, the tumor has probably been completely removed. In our patients, gastrin measurements after total gastrectomy had no prognostic significance in regards to clinical progression or regression of the neoplasm. Of 12 patients treated with cimetidine, nine experienced symptomatic improvement, and three did not. Resection of the gastrinoma should be attempted if the lesion is solitary and located in the body or tail of the pancreas, or if it is an isolated duodenal lesion. Otherwise, total gastrectomy remains the treatment of choice. In 38 patients, total gastrectomy with Roux-en-Y esophagojejunostomy was followed by 97% survival and minimal difficulties with nutrition or dumping.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Deveney C. W., Deveney K. S., Jaffe B. M., Jones R. S., Way L. W. Use of calcium and secretin in the diagnosis of gastrinoma (Zollinger-Ellison syndrome). Ann Intern Med. 1977 Dec;87(6):680–686. doi: 10.7326/0003-4819-87-6-680. [DOI] [PubMed] [Google Scholar]
  2. Fox P. S., Hofmann J. W., Decosse J. J., Wilson S. D. The influence of total gastrectomy on survival in malignant Zollinger-Ellison tumors. Ann Surg. 1974 Oct;180(4):558–566. doi: 10.1097/00000658-197410000-00020. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Fox P. S., Hofmann J. W., Wilson S. D., DeCosse J. J. Surgical management of the Zollinger-Ellison syndrome. Surg Clin North Am. 1974 Apr;54(2):395–407. doi: 10.1016/s0039-6109(16)40287-2. [DOI] [PubMed] [Google Scholar]
  4. Friesen S. R., Bolinger R. E., Pearse A. G., McGuigan J. E. Serum gastrin levels in malignant Zollinger-Ellison Syndrome after total gastrectomy and hypophysectomy. Ann Surg. 1970 Sep;172(3):504–521. doi: 10.1097/00000658-197009000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Ganguli P. C., Polak J. M., Pearse A. G., Elder J. B., Hegarty M. Antral-gastrin-cell hyperplasia in peptic-ulcer disease. Lancet. 1974 Apr 6;1(7858):583–586. doi: 10.1016/s0140-6736(74)92647-6. [DOI] [PubMed] [Google Scholar]
  6. Gottlieb B. Zollinger-Ellison syndrome, seven years after excision of pancreatic tumour containing gastrin. Proc R Soc Med. 1975 Dec;68(12):809–809. doi: 10.1177/003591577506801234. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Hansky J., Soveny C., Korman M. G. Value of serum gastrin in the diagnosis of the Zollinger-Ellison syndrome. Aust N Z J Med. 1973 Aug;3(4):349–354. doi: 10.1111/j.1445-5994.1973.tb03105.x. [DOI] [PubMed] [Google Scholar]
  8. Ingemansson S., Larsson L. I., Lunderquist A., Stadil F. Pancreatic vein catheterization with gastrin assay in normal patients and in patients with the Zollinger-Ellison syndrome. Am J Surg. 1977 Nov;134(5):558–563. doi: 10.1016/0002-9610(77)90433-0. [DOI] [PubMed] [Google Scholar]
  9. Jaffe B. M., Peskin G., Kaplan E. L. Diagnosis of occult Zollinger-Ellison tumors by gastrin radioimmunoassay. Cancer. 1972 Mar;29(3):694–700. doi: 10.1002/1097-0142(197203)29:3<694::aid-cncr2820290323>3.0.co;2-g. [DOI] [PubMed] [Google Scholar]
  10. Korman M. G., Scott D. F., Hansky J., Wilson H. Hypergastrinaemia due to an excluded gastric antrum: a proposed method for differentiation from the Zollinger ellison syndrome. Aust N Z J Med. 1972 Aug;2(3):266–271. doi: 10.1111/j.1445-5994.1972.tb03073.x. [DOI] [PubMed] [Google Scholar]
  11. Lamers C. G., Van Tongeren J. H. Comparative study of the value of the calcium, secretin, and meal stimulated increase in serum gastrin to the diagnosis of the Zollinger-Ellison syndrome. Gut. 1977 Feb;18(2):128–135. doi: 10.1136/gut.18.2.128. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Lewin M. R., Stagg B. H., Clark C. G. Gastric acid secretion and diagnosis of Zollinger-Ellison syndrome. Br Med J. 1973 Apr 21;2(5859):139–141. doi: 10.1136/bmj.2.5859.139. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. McCarthy D. M. Report on the United States experience with cimetidine in Zollinger-Ellision syndrome and other hypersecretory states. Gastroenterology. 1978 Feb;74(2 Pt 2):453–458. [PubMed] [Google Scholar]
  14. Morrow D. J., Passaro E., Jr Calcium infusion test before and after total gastrectomy in the Zollinger-Ellison syndrome. Am J Surg. 1975 Jan;129(1):62–66. doi: 10.1016/0002-9610(75)90168-3. [DOI] [PubMed] [Google Scholar]
  15. Oberhelman H. A., Jr Excisional therapy for ulcerogenic tumors of the duodenum: long-term results. Arch Surg. 1972 Apr;104(4):447–453. doi: 10.1001/archsurg.1972.04180040061011. [DOI] [PubMed] [Google Scholar]
  16. Sanzenbacher L. J., King D. R., Zollinger R. M. Prognostic implications of calcium-mediated gastrin levels in the ulcerogenic syndrome. Am J Surg. 1973 Jan;125(1):116–121. doi: 10.1016/0002-9610(73)90015-9. [DOI] [PubMed] [Google Scholar]
  17. Schrock T. R., Way L. W. Total gastrectomy. Am J Surg. 1978 Mar;135(3):348–355. doi: 10.1016/0002-9610(78)90064-8. [DOI] [PubMed] [Google Scholar]
  18. Stadil F., Rehfeld J. F. Determination of gastrin in serum. An evaluation of the reliability of a radioimmunoassay. Scand J Gastroenterol. 1973;8(2):101–112. [PubMed] [Google Scholar]
  19. Thompson J. C., Reeder D. D., Villar H. V., Fender H. R. Natural history and experience with diagnosis and treatment of the Zollinger-Ellison syndrome. Surg Gynecol Obstet. 1975 May;140(5):721–739. [PubMed] [Google Scholar]
  20. Waddell W. R., Coppinger W. R., Loughry R. W. Pancreaticoduodenectomy for Zollinger-Ellison syndrome. Ann Surg. 1968 Oct;168(4):641–654. doi: 10.1097/00000658-196810000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Way L., Goldman L., Dunphy J. E. Zollinger-Ellison syndrome. An analysis of twenty-five cases. Am J Surg. 1968 Aug;116(2):293–304. doi: 10.1016/0002-9610(68)90507-2. [DOI] [PubMed] [Google Scholar]
  22. ZOLLINGER R. M., ELLISON E. H. Primary peptic ulcerations of the jejunum associated with islet cell tumors of the pancreas. Ann Surg. 1955 Oct;142(4):709-23; discussion, 724-8. [PMC free article] [PubMed] [Google Scholar]
  23. Zboralske F. F., Amberg J. R. Detection of the Zollinger-Ellison syndrome: the radiologist's responsibility. Am J Roentgenol Radium Ther Nucl Med. 1968 Nov;104(3):529–543. doi: 10.2214/ajr.104.3.529. [DOI] [PubMed] [Google Scholar]

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