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. 1987 May;205(5):550–556. doi: 10.1097/00000658-198705000-00014

Localization and resection of gastrinomas in Zollinger-Ellison syndrome.

S B Vogel, M M Wolfe, J E McGuigan, I F Hawkins Jr, R J Howard, E R Woodward
PMCID: PMC1493021  PMID: 3579402

Abstract

From 1971-1986, 24 patients were diagnosed as having Zollinger-Ellison syndrome (ZES) and 22 patients had laparotomy. Of this group, gross tumor was identified in 15 of 22 patients. Ten of 15 patients had resection of their gastrinomas with the specific aim of curing the disease. This group had responded favorably to either cimetidine or ranitidine before operation. Preoperative transhepatic portal venous sampling (PVS) with gastrin determinations was performed in six patients; three patients had this procedure twice. The tumor was correctly localized by PVS in five of six patients. In four of six patients, the tumor was easily found at surgery. In two of six patients (33%) PVS was vital to intraoperative decisions. Criteria for biochemical cure are normal periodic fasting gastrin and secretin infusion tests. Of the 10 patients who had resection for potential cure, two patients failed within 48 hours of surgery on the basis of an elevated fasting serum gastrin level in one patient and a positive secretin infusion test in the other patient. Eight patients were considered cured with follow-up from 6 months through 15 years. Of the eight cured patients, the tumors were located as follows: four were extraintestinal and extrapancreatic, four were in the duodenal wall, one patient had a tumor located in the uncinate process of the pancreas, and one tumor was located in a lymph node along the lesser curve of the stomach. Two patients had mobilization of the pancreas and duodenum for a "blind" pancreatoduodenectomy based on preoperative PVS (2 procedures each patient). In one patient a 3-mm gastrinoma was enucleated from the posterior uncinate process. The second patient had pancreatoduodenectomy with findings of two duodenal wall gastrinomas. Both patients remained cured of ZES beyond 2 years. It is concluded that PVS does indeed locate some tumors before operation, even those not easily found at surgery. ZES can be cured by an aggressive approach combining preoperative tumor localization and tumor resection. Of the eight patients biochemically and perhaps biologically cured, follow-up was greater than four years in five patients, greater than two years in two patients, and beyond six months in one patient.

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Selected References

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

  1. Andrews R. C., Hawkins I. F. The Hawkins needle-guide system for percutaneous catheterization: 1. Instrumentation and procedure. AJR Am J Roentgenol. 1984 Jun;142(6):1191–1195. doi: 10.2214/ajr.142.6.1191. [DOI] [PubMed] [Google Scholar]
  2. Bonfils S., Landor J. H., Mignon M., Hervoir P. Results of surgical management in 92 consecutive patients with Zollinger-Ellison syndrome. Ann Surg. 1981 Dec;194(6):692–697. doi: 10.1097/00000658-198112000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Brennan M. F., Jensen R. T., Wesley R. A., Doppman J. L., McCarthy D. M. The role of surgery in patients with Zollinger-Ellison syndrome (ZES) managed medically. Ann Surg. 1982 Sep;196(3):239–245. doi: 10.1097/00000658-198209000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Burcharth F., Stage J. G., Stadil F., Jensen L. I., Fischermann K. Localization of gastrinomas by transhepatic portal catheterization and gastrin assay. Gastroenterology. 1979 Sep;77(3):444–450. [PubMed] [Google Scholar]
  5. Deveney C. W., Deveney K. E., Stark D., Moss A., Stein S., Way L. W. Resection of gastrinomas. Ann Surg. 1983 Oct;198(4):546–553. doi: 10.1097/00000658-198310000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Friesen S. R. Treatment of the Zollinger-Ellison syndrome. A 25 year assessment. Am J Surg. 1982 Mar;143(3):331–338. doi: 10.1016/0002-9610(82)90102-7. [DOI] [PubMed] [Google Scholar]
  7. Howard J. M., Chremos A. N., Collen M. J., McArthur K. E., Cherner J. A., Maton P. N., Ciarleglio C. A., Cornelius M. J., Gardner J. D., Jensen R. T. Famotidine, a new, potent, long-acting histamine H2-receptor antagonist: comparison with cimetidine and ranitidine in the treatment of Zollinger-Ellison syndrome. Gastroenterology. 1985 Apr;88(4):1026–1033. doi: 10.1016/s0016-5085(85)80024-x. [DOI] [PubMed] [Google Scholar]
  8. Jensen R. T., Gardner J. D., Raufman J. P., Pandol S. J., Doppman J. L., Collen M. J. Zollinger-Ellison syndrome: current concepts and management. Ann Intern Med. 1983 Jan;98(1):59–75. doi: 10.7326/0003-4819-98-1-59. [DOI] [PubMed] [Google Scholar]
  9. Malagelada J. R., Edis A. J., Adson M. A., van Heerden J. A., Go V. L. Medical and surgical options in the management of patients with gastrinoma. Gastroenterology. 1983 Jun;84(6):1524–1532. [PubMed] [Google Scholar]
  10. McArthur K. E., Collen M. J., Maton P. N., Cherner J. A., Howard J. M., Ciarleglio C. A., Cornelius M. J., Jensen R. T., Gardner J. D. Omeprazole: effective, convenient therapy for Zollinger-Ellison syndrome. Gastroenterology. 1985 Apr;88(4):939–944. doi: 10.1016/s0016-5085(85)80011-1. [DOI] [PubMed] [Google Scholar]
  11. McGuigan J. E., Wolfe M. M. Secretin injection test in the diagnosis of gastrinoma. Gastroenterology. 1980 Dec;79(6):1324–1331. [PubMed] [Google Scholar]
  12. Norton J. A., Doppman J. L., Collen M. J., Harmon J. W., Maton P. N., Gardner J. D., Jensen R. T. Prospective study of gastrinoma localization and resection in patients with Zollinger-Ellison syndrome. Ann Surg. 1986 Oct;204(4):468–479. doi: 10.1097/00000658-198610000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Norton J. A., Sugarbaker P. H., Doppman J. L., Wesley R. A., Maton P. N., Gardner J. D., Jensen R. T. Aggressive resection of metastatic disease in selected patients with malignant gastrinoma. Ann Surg. 1986 Apr;203(4):352–359. doi: 10.1097/00000658-198604000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Roche A., Raisonnier A., Gillon-Savouret M. C. Pancreatic venous sampling and arteriography in localizing insulinomas and gastrinomas: procedure and results in 55 cases. Radiology. 1982 Dec;145(3):621–627. doi: 10.1148/radiology.145.3.6292994. [DOI] [PubMed] [Google Scholar]
  15. Stabile B. E., Morrow D. J., Passaro E., Jr The gastrinoma triangle: operative implications. Am J Surg. 1984 Jan;147(1):25–31. doi: 10.1016/0002-9610(84)90029-1. [DOI] [PubMed] [Google Scholar]
  16. Thompson J. C., Lewis B. G., Wiener I., Townsend C. M., Jr The role of surgery in the Zollinger-Ellison syndrome. Ann Surg. 1983 May;197(5):594–607. doi: 10.1097/00000658-198305000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Wolfe M. M., Alexander R. W., McGuigan J. E. Extrapancreatic, extraintestinal gastrinoma: effective treatment by surgery. N Engl J Med. 1982 Jun 24;306(25):1533–1536. doi: 10.1056/NEJM198206243062506. [DOI] [PubMed] [Google Scholar]
  18. Wolfe M. M., Jain D. K., Edgerton J. R. Zollinger-Ellison syndrome associated with persistently normal fasting serum gastrin concentrations. Ann Intern Med. 1985 Aug;103(2):215–217. doi: 10.7326/0003-4819-103-2-215. [DOI] [PubMed] [Google Scholar]

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