Abstract
It is often difficult to localize gastrinomas in patients with Zollinger-Ellison syndrome (ZES). We have developed a new useful method, the selective arterial secretin injection test (SASI test), for localizing gastrinomas in patients with ZES. The SASI test first determines the arteries feeding the gastrinomas and then locates the gastrinomas. In 12 patients with ZES, the SASI test clearly localized the gastrinomas, while results obtained with computed tomography or portal venous blood sampling had a positive predictability of less than 10%. Following localization with the SASI test, curative resection of gastrinomas was successfully performed on 7 patients who consented to the operation. Each of 3 patients had one duodenal submucosal microgastrinoma and one or more metastatic lymph node; the other 4 patients had 2 to 10 microgastrinomas or large gastrinomas in the duodenum or the pancreas. All 7 patients, who exhibited negative responses with a postoperative secretin test, have been completely cured from 3 months to 4 years postoperatively. The usefulness of the SASI test for preoperative evaluation is demonstrated by the fact that it gives a 100% positive predictability rate as well as a 100% negative predictability rate. Hence the SASI test precisely locates functioning gastrinomas.
Résumé
Il est souvent difficile de localiser les gastrinomes responsables d'un syndrome de Zollinger-Ellison (SZE). Nous avons développé une méthode pour localiser ces tumeurs qui consiste à doser la gastrine sanguine après injection sélective de sécrétine par voie artérielle (ISSA). Dans un premier temps, on peut déterminer les artères nourricières de la tumeur, et ensuite localiser la tumeur. Chez 12 patients ayant un SZE, l'ISSA a permis de localiser correctement la tumeur, alors que les investigations traditionnelles par tomodensitométrie ou les dosages dans le sang veineux porte avaient une valeur prédictive positive inférieure à 10%. Après localisation du gastrinome par ce test, la résection curative a été réalisée chez sept patients ayant accepté l'intervention. Trois de ces patients avaient un microgastrinome sousmuqueux du duodénum, avec une ou plusieurs métastases ganglionnaires et quatre patients avaient entre 2 et 10 micro ou macro gastrinomes du duodénum ou du pancréas. Les sept patients avaient tous un test ISSA négatif après l'intervention avec un suivi allant de 3 mois à 4 ans. L'utilité de ce test en préopératoire est démontrée par le fait que les valeurs prédictives positive et négative sont de 100%. Le test ISSA localise avec précision les gastrinomes fonctionnels.
Resumen
Con frecuencia es muy difícil localizar los gastrinomas en pacientes con síndrome de Zollinger-Ellison (SZE). Hemos desarrollado un nuevo y útil método, la prueba de Inyección Arterial Selectiva de Secretina (PIASS), para la localización de gastrinomas en el SZE. La PIASS es un método que primero determina las arterias que nutren los gastrinomas y luego establece su localización. En todos los 12 casos de SZE, la PIASS localizó claramente los gastrinomas, mientras los resultados de la tomografía computadorizada o del muestreo venoso portal exhibieron una predictibilidad positiva de menos del 10%. Luego de la localización de los gastrinomas por la PIASS, se realizó la resección curativa exitosamente en 7 pacientes que dieron su consentimiento para la operación. Cada uno de tres pacientes presentaba un microgastrinoma submucoso duodenal y uno o más ganglios linfáticos metastásicos, y otros cuatro pacientes tenían 2 a 10 micro o grandes gastrinomas en el duodeno o el páncreas. Todos los 7 pacientes presentaron respuestas negativas con la prueba postoperatoria de secretina, y han sido totalmente curados a los 3 meses-4 años después de la operación. La utilidad de la PIASS como examen preoperatorio queda demostrada por el hecho de que provee una predictibilidad del 100% y también por una tasa de predictibilidad negativa de 100%. La PIASS logra la localización preoperatoria precisa de gastrinomas funcionantes.
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Imamura, M., Takahashi, K. Use of selective arterial secretin injection test to guide surgery in patients with Zollinger-Ellison syndrome. World J. Surg. 17, 433–438 (1993). https://doi.org/10.1007/BF01655100
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DOI: https://doi.org/10.1007/BF01655100