Gastrinomas: localization by means of selective intraarterial injection of secretin.

Abstract

Small doses (30 U) of secretin were injected directly into the splenic, gastroduodenal, hepatic, and superior mesenteric arteries of 13 patients with Zollinger-Ellison syndrome who were undergoing angiography to localize gastrin-secreting tumors of the islet cells. Blood samples from the right hepatic vein and a peripheral vein were drawn before and 30, 60, 120, and 210 seconds after each intraarterial secretin (IAS) injection. A 50% rise in gastrin level in the 30-second sample from the hepatic vein localized the gastrinoma to the head, body, or tail of the pancreas, depending on the artery into which secretion was injected. IAS results were positive in seven of 13 patients (54%); selective angiography was positive in five of 13 (38%); and the combined study, selective angiography with IAS injection, was positive in 10 of 13 (77%). Portal venous sampling was positive in six of 13 (46%). Selective IAS injection, combined with angiography, is the most sensitive study for localizing gastrinomas and avoids percutaneous transhepatic catheterization for portal venous sampling.

Gastrinoma (Duodenal and Pancreatic)

“…EUS is particularly sensitive for pancreatic lesions; however, its ability to detect small duodenal tumors is controversial [21, 43, 44]. Functional localization studies are not limited by tumor size but are invasive studies [45, 46]. Prospective studies show for metastatic gastrinoma to the liver that CT and ultrasound detect their presence in 30–50% of patients with metastases, MRI and angiography in 60–75% and SRS in 92% [33, 34].…”

Neuroendocrine tumours.

“…gastrin or insulin). In the presence of a tumour, the hormone levels double after 30 s, whereas the normal effect is a reduction in levels (Doppman et al 1990, Fedorak et al 1993, Goldstone et al 1996, O'Shea et al 1996. The tremendous advantage of this technique is that it allows biochemical localization of the tumour (e.g.…”

GEP-NETs update: Functional localisation and scintigraphy in neuroendocrine tumours of the gastrointestinal tract and pancreas (GEP-NETs)

“…Therefore, the role of angiography and ASVS using secretin or calcium gluconate for localising gastrinomas is less clear-cut than in insulinomas. ASVS will provide both anatomical and functional information about the site of the gastrinoma and can be particularly useful for the difficult localisation of a sporadic duodenal gastrinoma (86,87,88).…”