Recently a number of surgeons have recommended radical resection of
gastrinomas in
Zollinger-Ellison syndrome (ZES). We have developed a useful technique for preoperative localization of
gastrinomas--the selective arterial
secretin injection test (SASI)--and we recommend an intraoperative
secretin test (IOS) for deciding the radicality of resection of
gastrinomas. Here the results of SASI and IOS tests in 11 patients with ZES are examined and compared with the results of other techniques. The SASI test localized
gastrinomas in all of the patients, while the sensitivity of ultrasonography, computed tomography, arteriography, or portal venous blood samplings was between 1/11 and 5/11. On the basis of the results of the SASI test, radical resection of
gastrinoma was performed in four patients (three
pancreatoduodenectomies and one extirpation). After
pancreatoduodenectomy, immunohistologic study of the specimen revealed multiple microgastrinomas and
lymph node metastases in two patients and the coexistence of a microgastrinoma and a gastinoma in one patient. The IOS test was useful in the estimation of the advisability of radicality, and in two patients total
gastrectomy was not performed because of the results of the IOS test. These four patients are well and have returned to work, and their serum
gastrin levels are below 35 pg/mL. Thus we believe SASI and IOS tests are helpful for planning curative resection of
gastrinomas.