Selective surgical management of correctable hypergastrinemia.
Sixty patients with surgically correctable hypergastrinemia were treated between 1960 and 1988. Provocative testing was used when available to select appropriate operations. Sources of hypergastrinemia included antral G cell hyperplasia (AGCH) (17), pancreatic gastrinomas (14), duodenal gastrinomas (11), multiple gastrinomas in patients with type I multiple endocrine neoplasia (MEN I) (five), lymph node gastrinomas (four), and the source not found in nine patients. Eugastrinemia was achieved by resection in 17 of 17 patients with AGCH, nine of 11 patients with duodenal gastrinomas, three of four patients with lymph node gastrinomas, zero of 14 patients with pancreatic gastrinomas, zero of five patients with MEN I, and zero of nine patients in whom the source was not found. Hepatic metastases developed in 11 patients with pancreatic gastrinomas, two patients with MEN I, one patient with duodenal gastrinomas, and one patient with lymph node gastrinomas. One patient in whom the source of the hypergastrinemia was not found developed hepatic metastases, and seven required total gastrectomy. This experience suggests the following: (1) that patients with AGCH, duodenal gastrinomas, or lymph node gastrinomas can usually be rendered eugastrinemic by resection; (2) that patients with pancreatic gastrinomas, whether sporadic or familial (MEN I), are rarely cured by resection and frequently develop hepatic metastases; and (3) that patients in whom the source of the hypergastrinemia is not identified and removed frequently require total gastrectomy, but antroduodenectomy should be considered because it may uncover an occult duodenal microneurogastrinoma or may correct AGCH.
Delcore
R
R
Department of Surgery, University of Kansas School of Medicine, Mo.
Hermreck
A S
AS
Friesen
S R
SR
D014408:Biomarkers, Tumor / Q000097:blood*; D004379:Duodenal Neoplasms / Q000097:blood / Q000601:surgery*; D004435:Eating; D005260:Female; D005500:Follow-Up Studies; D015408:Gastrinoma / Q000097:blood / Q000601:surgery*; D005755:Gastrins / Q000097:blood* / Q000378:metabolism; D006801:Humans; D006965:Hyperplasia; D008297:Male; D008875:Middle Aged; D009377:Multiple Endocrine Neoplasia / Q000097:blood / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000097:blood / Q000601:surgery*; D011379:Prognosis; D012633:Secretin; D013270:Stomach / Q000473:pathology / Q000601:surgery; D013274:Stomach Neoplasms / Q000097:blood / Q000601:surgery*
D014408:Biomarkers, Tumor; D005755:Gastrins; D012633:Secretin