| Theme |
Pancreatic Endocrine Tumors |
| Title |
Zollinger-Ellison Syndrome:Current Concepts and Strategies |
| Author |
Soichi Tomimatsu |
First Department of Surgery, National Defense Medical College |
| Author |
Takashi Ichikura |
First Department of Surgery, National Defense Medical College |
| [ Summary ] |
Current strategies for Zollinger-Ellison syndrome (ZES) are reviewed herein and two cases of ZES are also reported. Case 1 is a 47-year-old man who underwent gastrectomy for gastric ulcer bleeding. Case 2 is a 63 year-old woman who was preoperatively diagnosed as having ZES and underwent distal pancreatectomy with partial hepatectomy for liver metastasis.
Patients with ZES suffer from severe, complicated peptic ulceration and diarrhea due to hypergastrinemia. Gastrinomas often localize in the pancreas, duodenum, and gallbladder. Over 60% of gastrinomas metastasize to the liver or to lymph nodes. The diagnosis is made by measuring gastric acid production and the fasting serum gastrin level, as well as the secretin stimulation test. Selective arterial secretin injection and percutaneous transhepatic portal venous sampling are useful for determining the locations of gastrinomas. Complete tumor resection is the optimal therapy. When the gastrinoma cannot be detected or cannot be removed completely, suppression of gastric acid secretion with a proton pump inhibitor is indicated. |