Localization of gastrinomas by selective intra-arterial calcium injection in patients on proton pump inhibitor or H2 receptor antagonist therapy.
Preoperative localization is important for the successful treatment of gastrinomas. The aim of this study was to investigate whether selective intra-arterial calcium injection and hepatic venous sampling was able to localize gastrinomas in four patients who remained on proton pump inhibitor or H2 antagonist therapy. Calcium gluconate was injected directly into the arteries supplying the pancreas and liver after standard selective angiography. Gastrin levels were then measured in samples taken from the right hepatic vein. Calcium gluconate produced a diagnostic rise (at least 2-fold) in serum gastrin and unequivocally localized the tumour to a specific vascular territory in each case. One patient did not undergo surgery. In the remaining three patients, surgery confirmed the position and histology of the tumour. This study shows that in four patients with a confirmed gastrinoma we were able to localize the gastrinoma by selective intra-arterial calcium injection and hepatic venous sampling, whilst the patients remained on proton pump inhibitor or H2 antagonist therapy, thereby reducing their risk of gastrointestinal perforation.
Dhillo
Waljit S
WS
Department of Endocrinology, Imperial College Faculty of Medicine, Hammersmith Hospital, London W12 0NN, UK.
Jayasena
Channa N L
CN
Jackson
James E
JE
Lynn
John A
JA
Bloom
Stephen R
SR
Meeran
Karim
K
Todd
Jeannie F
JF
D000328:Adult; D001800:Blood Specimen Collection; D002125:Calcium Gluconate; D005260:Female; D015408:Gastrinoma / Q000175:diagnosis* / Q000188:drug therapy; D006503:Hepatic Veins; D006635:Histamine H2 Antagonists / Q000627:therapeutic use*; D006801:Humans; D007269:Injections, Intra-Arterial; D007416:Intestinal Perforation / Q000517:prevention & control; D008099:Liver / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use; D010179:Pancreas / Q000098:blood supply; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000188:drug therapy; D054328:Proton Pump Inhibitors; D011899:Ranitidine / Q000627:therapeutic use; D013268:Stimulation, Chemical
D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors; D011899:Ranitidine; D009853:Omeprazole; D002125:Calcium Gluconate