Fifty-five consecutive patients with
Zollinger-Ellison syndrome who underwent exploratory
laparotomies for
gastrinoma resection were evaluated prospectively to determine the effect of
gastrinoma resection on
acid secretion and to establish criteria for safe and effective perioperative management of gastric acid hypersecretion. In 15 patients (27%) no
tumor was found and postoperative serum
gastrin, basal
acid output (BAO), and maximal
acid output (
MAO) were unchanged. Twenty-one patients (38%) had
gastrinomas resected and were biochemically cured. Median fasting
gastrin, median delta
secretin, mean BAO, and mean
MAO decreased 89%, 94%, 80%, and 43%, respectively, at 3-month follow-up in these patients. In 19 patients
gastrinomas were resected, but patients were not cured, and median fasting
gastrin, median delta
secretin, mean BAO, and mean
MAO decreased 47%, 10%, 26%, and 25%, respectively. Forty percent of patients with
gastrinoma resected and cured and 81% of patients with
gastrinoma resected but not cured continued to hypersecrete
acid (BAO greater than 10 mEq/hr) at 3- to 6-month follow-up.
Acid control was managed perioperatively during
gastrinoma resection by continuous
intravenous infusion of H2 receptor antagonists at a dose established by preoperative titration to decrease
acid output to less than 10 mEq/hr. Thirty patients were treated with
cimetidine at a mean dose of 3.2 mg/kg/hr for a mean of 13.8 days. Twenty-one patients were treated with
ranitidine at a mean dose of 1.1 mg/kg/hr for a mean of 8 days. No patients suffered any complications related to
acid hypersecretion or side effects of the H2 antagonists. Patients undergoing
gastrinoma resection can be managed safely by continuous infusion of H2 antagonists. Successful
gastrinoma resection can reduce
acid output, but even 40% of biochemically cured patients will continue to hypersecrete
acid at short-term follow-up and will require continuation of antisecretory medication.