Use of selective arterial secretin injection test to guide surgery in patients with Zollinger‐Ellison syndrome

Imamura, Masayuki; Takahashi, Kazuhisa

doi:10.1007/bf01655100

Cited by 66 publications

(45 citation statements)

References 16 publications

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“…Typically, the secreting tumors, such as gastrinomas and or insulinomas, are smaller than the non-secreting tumors when being detected (due to the hormone induced syndromes). Sizes vary between some millimeters and 4 cm [58]. Insulinomas are reported to be smaller than gastrinomas at the time of diagnosis.…”

Section: Computed Tomographymentioning

confidence: 97%

Morphological and functional investigations of neuroendocrine tumors of the pancreas

Pereira

Wiskirchen

2003

Eur Radiol

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Neuroendocrine tumors of the pancreas are rare neoplasms arising predominantly from the pancreatic islets of Langerhans and are thus known as islet cell tumors. More than the half of all neuroendocrine tumors are called functioning islet cell tumors because they secrete one or more biologically active peptides that may produce clinical symptoms. Clinical diagnosis of non-functioning, i.e., biologically inactive, tumors is often delayed and patients tend to present with advanced tumors (size greater than 5 cm) that are easily localized by using conventional imaging modalities. On the other hand, symptoms of functioning islet cell tumors usually appear early in the clinical course, rendering the preoperative localization of these small hormone-producing tumors (size less than 2 cm) difficult with non-invasive methods. Since functioning islet cell tumors can often be cured by surgical resection, invasive procedures are warranted when necessary for localization diagnosis. Failure to search for, detect, and resect these small tumors will invariably result in persistent symptoms. Regarding the unsatisfactory results of morphological imaging methods, functional studies, especially arterial stimulation with hepatic venous samplings, may provide a preoperative regionalization of the pancreatic adenoma, regardless of its size.

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Section: Computed Tomographymentioning

confidence: 97%

Morphological and functional investigations of neuroendocrine tumors of the pancreas

Pereira

Wiskirchen

2003

Eur Radiol

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“…EUS can detect pancreatic and some duodenal tumours and lymph gland metastases, but would be less efficient with the smallest duodenal tumours [3]. An intra-arterial selective stimulation test (SAS, Imamura test) was originally developed with pentagastrin for gastrinoma, which may provide tumour regionalization and demonstrate possible liver metastases [9]. It is, however, important to submit the gastrinoma patients to surgery, even in the absence of positive localization diagnosis, since especially these patients may have resectable duodenal gastrinomas.…”

Section: Gastrinoma – Zollinger-ellison Syndromementioning

confidence: 99%

Surgical Treatment of Endocrine Pancreatic Tumours

Åkerström¹,

Hellman²,

Hessman³

et al. 2004

Neuroendocrinology

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Endocrine pancreatic tumours (EPTs) are uncommon, with a major challenge to alert physicians to their recognition and requirements of treatment. Functioning EPTs cause well-known clinical syndromes of hormone excess. Insulinomas, gastrinomas and glucagonomas are most common; vipomas and somatostatinomas are rare. EPTs also occur as non-functioning lesions without symptoms of hormone excess occasionally with ectopic hormone, such as ACTH and Cushing syndrome as a late complication. The majority of EPTs are sporadic, but they may also be part of a multiple endocrine neoplasia type 1 syndrome or rarely the von Hippel-Lindau syndrome. EPTs have been of great interest to endocrine surgeons and we have, during recent years, witnessed continuing advances in diagnosis, imaging and treatment of the different tumour entities. It has become obvious that surgical treatment of these tumours is of increased concern and can have a marked impact on symptoms and survival.

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“…Pre-operative localisation with CT scan and selective angiography [9]was successful in identifying 6 of 7 pancreatic primaries without the need for more invasive tests such as arterial secretin stimulation [10]or transhepatic portal venous sampling [11], which at best can only regionalise the lesion. Octreotide scintigraphy may have high sensitivity and specificity for neuro-endocrine tumours [12], but was only used in 2 patients as it has only recently become more widely available.…”

Section: Discussionmentioning

confidence: 99%

Achieving Eugastrinaemia in Zollinger-Ellison Syndrome: Resection or Enucleation?

2001

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Background: Eugastrinaemia in Zollinger-Ellison syndrome can be an elusive goal, nearly one third of laparotomies failing to detect the tumour. Methods: A personal series of 13 patients with a mean age of 52 years operated between 1980 and 1996 was reviewed retrospectively. All patients had fasting hypergastrinaemia and recalcitrant ulcer disease with or without diarrhoea. Results: Computed tomography or selective visceral angiography localised the tumour to the pancreas in 6 of 12 elective patients; the thirteenth presented with a perforated duodenal ulcer. All underwent laparotomy with gastrinoma tissue being completely excised in every case, including the 6 patients with failed pre-operative localisation whose tumours arose from the duodenum (4), pancreas (1) and lymph node (1). Eugastrinaemia was achieved in all but 1 patient and was sustained during a mean follow-up of 5.2 years (SD = 4.2 years). These 12 patients remained clinically free of disease during a mean clinical follow-up of 7.5 years (SD = 5.0 years; range 2–19 years). There were no postoperative deaths, but 3 died from recurrent tumour at 3–7 years. Conclusion: Since normalisation of serum gastrin was achieved in 12 of 13 patients, laparotomy may well be worthwhile even if the gastrinoma cannot be localised pre-opera- tively.

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Use of selective arterial secretin injection test to guide surgery in patients with Zollinger‐Ellison syndrome

Cited by 66 publications

References 16 publications

Morphological and functional investigations of neuroendocrine tumors of the pancreas

Morphological and functional investigations of neuroendocrine tumors of the pancreas

Surgical Treatment of Endocrine Pancreatic Tumours

Achieving Eugastrinaemia in Zollinger-Ellison Syndrome: Resection or Enucleation?

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