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Achieving eugastrinaemia in Zollinger-Ellison syndrome: resection or enucleation?

AbstractBACKGROUND:
Eugastrinaemia in Zollinger-Ellison syndrome can be an elusive goal, nearly one third of laparotomies failing to detect the tumour.
METHODS:
A personal series of 13 patients with a mean age of 52 years operated between 1980 and 1996 was reviewed retrospectively. All patients had fasting hypergastrinaemia and recalcitrant ulcer disease with or without diarrhoea.
RESULTS:
Computed tomography or selective visceral angiography localised the tumour to the pancreas in 6 of 12 elective patients; the thirteenth presented with a perforated duodenal ulcer. All underwent laparotomy with gastrinoma tissue being completely excised in every case, including the 6 patients with failed pre-operative localisation whose tumours arose from the duodenum (4), pancreas (1) and lymph node (1). Eugastrinaemia was achieved in all but 1 patient and was sustained during a mean follow-up of 5.2 years (SD = 4.2 years). These 12 patients remained clinically free of disease during a mean clinical follow-up of 7.5 years (SD = 5.0 years; range 2-19 years). There were no postoperative deaths, but 3 died from recurrent tumour at 3-7 years.
CONCLUSION:
Since normalisation of serum gastrin was achieved in 12 of 13 patients, laparotomy may well be worthwhile even if the gastrinoma cannot be localised pre-opera- tively.
AuthorsP A Thodiyil, N S El-Masry, R C Williamson
JournalDigestive surgery (Dig Surg) Vol. 18 Issue 2 Pg. 118-23 ( 2001) ISSN: 0253-4886 [Print] Switzerland
PMID11351156 (Publication Type: Journal Article)
CopyrightCopyright 2001 S. Karger AG, Basel
Chemical References
  • Gastrins
Topics
  • Adult
  • Aged
  • Angiography, Digital Subtraction
  • Fasting
  • Female
  • Gastrectomy (adverse effects, methods)
  • Gastrins (blood)
  • Gastroscopy
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local (mortality)
  • Pancreatectomy (adverse effects, methods)
  • Pancreaticoduodenectomy (adverse effects, methods)
  • Retrospective Studies
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Zollinger-Ellison Syndrome (blood, diagnosis, surgery)

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