World Journal of Surgery

, Volume 30, Issue 1, pp 1–11

Changing Treatment Strategy for Gastrinoma in Patients with Zollinger-Ellison Syndrome

  • Masayuki Imamura
  • Izumi Komoto
  • Shuichi Ota


We overviewed the recent development of curative surgery for gastrinoma that has been rapidly improved since the development of new localization techniques, especially the selective arterial secretagogue injection test (SASI test) and somatostatin receptor scintigraphy (SRS). A number of new pathological findings of gastrinomas in patients with Zollinger-Ellison syndrome have been accumulated in accordance with the increase of curative resection of gastrinomas, and these new findings also have contributed to the progress of the treatment strategy for grastrinomas.


  1. 1.
    Zollinger RM. Treatment of gastrinoma. Mout Sinai J Med 1984;51:401–403Google Scholar
  2. 2.
    Imamura M, Takahashi K, Adachi H, et al. Usefulness of selective arterial secretin injection test for localization of gastrinoma in Zollinger-Ellison syndrome. Ann Surg 1987;205:230–239PubMedGoogle Scholar
  3. 3.
    Rosato FE, Bonn J, Shapiro M, et al. Selective arterial stimulation of secretin in localization of gastrinomas. Surg Gynecol Obstet 1990;171:196–200PubMedGoogle Scholar
  4. 4.
    Doppman JL. Pancreatic endocrine tumors—the search goes on. N Engl J Med 1992;326:1770–1772PubMedCrossRefGoogle Scholar
  5. 5.
    Stamm B, Hacki WH, Kloppel G, et al. Gastrin-producing tumors and the Zollinger-Ellison syndrome. In Dayal Y, editor, Endocrine Pathology of the Gut and Pancreas, Boca Raton, FL, CRC Press, 1991;155–194Google Scholar
  6. 6.
    Thompson NW, Vinik AI, Eckhauser FE. Microgastrinoma of the duodenum a cause of failed operations for the Zollinger-Ellison syndrome. Ann Surg 1989;209:396–404PubMedGoogle Scholar
  7. 7.
    Schroeder W, Hoelscher AH, Beckurts KT, et al. Surgical therapy of gastrinoma with associated Zolinger-Ellison syndrome. Z Gastroenterol 1996;34:465–472Google Scholar
  8. 8.
    Thodiyil PA, El-Masry NS, Williamson RC. Achieving eugastrinaemia in Zollinger-Ellison syndrome: resection or enucleation? Dig Surg 2001;18:118–123PubMedCrossRefGoogle Scholar
  9. 9.
    Oberhelman HA Jr, Nelsen TS, Johnson AN, et al. Ulcerogenic tumors of the duodenum. Ann Surg. 1961;153:214–227PubMedCrossRefGoogle Scholar
  10. 10.
    Oberhelman HA Jr. Excisional therapy for ulcerogenic tumors of the duodenum.: long term results. Arch Surg 1972;104:447–453PubMedGoogle Scholar
  11. 11.
    Plockinger U, Wiedenmann. Neuroendocrine tumors of the gastro-entero-pancreatic system: the role of early diagnosis, genetic testing and preventive surgery. Dig Dis 2002;20:49–60PubMedGoogle Scholar
  12. 12.
    Jensen RT. Zollinger-Ellison syndrome. In Doherty GM, Skogseid B, editors, Surgical Endocrinology, Philadelphia, Lippincott Williams & Wilkins, 2001;291–343Google Scholar
  13. 13.
    Madeira I, Terris M, Voss M, et al. Prognostic factors in patients endocrine tumors of the duodenopancreatic area. Gut 1998;43:422–427PubMedCrossRefGoogle Scholar
  14. 14.
    Imamura M, Takahashi K, Isobe Y, et al. Curative resection of multiple gastrinomas aided by selective arterial secretin injection test and intraoperative secretin test. Ann Surg 1989;210:710–718PubMedGoogle Scholar
  15. 15.
    Lairmore TC, Piersall LD, DdeBenedetti MK, et al. Clinical genetic testing and early surgical intervention in patients with multiple endocrine neoplasia type 1 (MEN1). Ann Surg 2004;239:637–647PubMedGoogle Scholar
  16. 16.
    Imamura M, Takahashi K. Use of selective arterial secretin injection test to guide surgery in patients with Zollinger-Ellison syndrome. World J Surg 1993;17:433–438PubMedCrossRefGoogle Scholar
  17. 17.
    Imamura M. Establishment of a new strategy for gastrinomas based on the basic research on endocrine tumors. Formosan J Surg 1999;32:197–201Google Scholar
  18. 18.
    Sarmiento JM, Farnell MB, Que FG, et al. Pancreaticoduodenectomy for islet tumors of the head of the pancreas. World J Surg 2002;26:1267–1271PubMedCrossRefGoogle Scholar
  19. 19.
    Norton JA, Jensen RT. Resolved and unsolved controversies in the surgical management of patients with Zolinger-Ellison syndrome. Ann Surg 2004;240:757–773PubMedGoogle Scholar
  20. 20.
    Krenning EP, Kwekkeboom DJ, Oei HY. Somatostatin receptor scintigraphy in gastroenteropancreatic tumors. Ann N Y Acad Sci 1994;733:41–424Google Scholar
  21. 21.
    Clark OH. What’s new in endocrine surgery. J Am Coll Surg 1997;184:126–136PubMedGoogle Scholar
  22. 22.
    Imamura M, Kanda M, Takahashi K, et al. Clinicopathological characteristics of duodenal microgastrinomas. World J Surg 1992;16:703–709PubMedCrossRefGoogle Scholar
  23. 23.
    Pipeleers-Marichal M, Donow C, Heiz PU, et al. Pathologic aspects of gastrinomas in patients with Zollinger-Ellison syndrome with and without multiple endocrine neoplasia type 1. World J Surg 1993;17:481–488PubMedCrossRefGoogle Scholar
  24. 24.
    Thompson NW. Current concepts in the surgical management of multiple endocrine neoplasia type 1 pancreatic-duodenal disease. Results in the treatment of 40 patients with Zollinger-Ellison syndrome, hypoglycemia or both. J Intern Med 1997;243:495–500Google Scholar
  25. 25.
    Delcore R, Cheung LY, Friesen SR. Outcome of lymph node involvement in patients with the Zollinger-Ellison syndrome. Ann Surg 1988;208:291–298PubMedGoogle Scholar
  26. 26.
    Gibril F, Venzon DJ, Ojeaburu JV, et al. Prospective study of the natural history of gastrinoma in patients with MEN-1: definition of an aggressive and a nonaggressive form. J Clin Endocrinol Metab 2001;86:5282–5293PubMedCrossRefGoogle Scholar
  27. 27.
    Zogakis TG, Gibril F, Libutti SK, et al. Management and outcome of patients with sporadic gastrinoma arising in the duodenum. Ann Surg 2003;238:42–48PubMedCrossRefGoogle Scholar
  28. 28.
    Imamura M, Adachi H, Takahashi K, et al. Gastrin release from gastrinoma cells stimulated with secretin. Dig Dis Sci 1982;27:1130–1136PubMedCrossRefGoogle Scholar
  29. 29.
    Passaro E Jr, Basso N, Walsh JH. Calcium challenge in the Zollinger-Ellison syndrome. Surgery 1972;72:60–67PubMedGoogle Scholar
  30. 30.
    Itami A, Kato M, Komoto I, et al. Human gastrinoma cells express calcium-sensing receptor. Life Sci 2001;70:119–127PubMedCrossRefGoogle Scholar
  31. 31.
    Doppman JL, Miller DL, Chang R, et al. Gastrinomas:localization by means of selective intraarterial injection of secretin. Radiology 1990;174:25–29PubMedGoogle Scholar
  32. 32.
    Wada M, Komoto I, Doi R, et al. Intravenous calcium injection test is a novel complementary procedure in differential diagnosis for gastrinoma. World J Surg 2002;26:1291–1299PubMedCrossRefGoogle Scholar
  33. 33.
    Turner LLO, Wren AM, Jackson JE, et al. Localization of gastrinomas by selective intra-arterial calcium injection. Clin Endocrinol 2002;57:821–825CrossRefGoogle Scholar
  34. 34.
    Noda S, Norton JA, Jensen RT, et al. Surgical resection of intracardiac gastrinoma. Ann Thorac Surg 1999;67:532–553PubMedCrossRefGoogle Scholar
  35. 35.
    Kato M, Imamura M, Hosotani R, et al. Curative resection of microgastrinomas based on the intraoperative secretin test. World J Surg 2000;24:1425–1430PubMedGoogle Scholar
  36. 36.
    Chen H, Hardare JM, Uzar A, et al. Isolated liver metastases from neroendocrine tumors: does resection prolong survival? J Am Coll Surg 1998;187:88–93PubMedCrossRefGoogle Scholar
  37. 37.
    Okuzawa A, Kobayashi S, Sakamoto K, et al. Metastatic gastrinoma to the liver after primary resection. J Gastroenterol 2000;35:717–720PubMedCrossRefGoogle Scholar
  38. 38.
    Fraker DL, Norton JA, Alexander HR, et al. Surgery in Zollinger-Ellison syndrome alters the natural history of gastrinoma. Ann Surg 1994;220:320–330PubMedGoogle Scholar
  39. 39.
    Imamura M, Komoto I, Doi R, et al. New pancreas-preserving total duodenectomy technique. World J Surg 2005;29:203–207PubMedGoogle Scholar
  40. 40.
    Chung RS, Church JM, Stolk R. Pancreas-sparing duodenectomy: indications, surgical technique, and results. Surgery 1995;117:254–259PubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2005

Authors and Affiliations

  • Masayuki Imamura
    • 1
    • 2
  • Izumi Komoto
    • 1
  • Shuichi Ota
    • 1
  1. 1.Department of SurgeryOsaka Saiseikai Noe HospitalJoto-kuJapan
  2. 2.Professor EmeritusKyoto UniversitySakyo-kuJapan

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