Abstract
The emergency management of patients presenting with the Zollinger-Ellison syndrome (ZES) consists of medical measures to control acid-pepsin hypersecretion; emergency surgery should be confined to urgent complications of ulceration or tumor growth and spread. Operation for ulcer complications should be restricted to conventional surgical procedures with biopsy of suspicious lesions. Emergency total gastrectomy or resection of pancreas and duodenum is contraindicated. Once the emergency has been controlled, the diagnosis of ZES can be confirmed by basal serum gastrin measurements and the secretin provocation test. Other endocrine adenopathies should be excluded. An attempt is then made to localize the tumor(s) and any metastases. With techniques such as selective portal venous sampling, it may be possible to define the small group of patients with lesions amenable to surgical cure. For the remainder, continued control of gastric secretion can be achieved by H2-receptor antagonists, but elective total gastrectomy or the combination of vagotomy with pharmacological blockade offer valid alternatives in long-term management. Effective medical or surgical control of the peptic ulcer diathesis means that tumor progression is now the major cause of death in ZES patients, and advances in the fields of chemotherapy and radiotherapy are urgently required to control this aspect of the disease.
Résumé
Le traitement des malades atteints de Syndrome de Zollinger-Ellison consiste dans l'emploi d'agents thérapeutiques susceptibles de contrôler l'hypersecrétion acido-peptique gastrique. Le traitement chirurgical est à réserver aux complications de l'ulcère et aux tumeurs à développement et à extension rapide. Les complications ulcéreuses doivent être traitées par les méthodes conventionnelles cependant que la biopsie des lésions doit être systématique lors de l'intervention.
La gastrectomie totale d'urgence ou la duodénopancréatectomie sont contre-indiquées.
Le diagnostic de Zollinger Ellison doit de toute façon être confirmé par le dosage de la gastrinémie et par le test à la secrétine. Les tumeurs endocriniennes éventuellement associées doivent être recherchées systématiquement. Il convient également de localiser la tumeur et ses éventuelles métastases à l'aide du prélèvement étage du sang portai de façon à définir les lésions susceptibles d'être guéries chirurgicalement. Le contrôle définitif de l'hypersécrétion acido-peptique peut être obtenu par l'administration permanente des antagonistes H2-recepteurs encore qua le gastrectomie totale élective ou que l'association de la vagotomie hypersélective et des antagonistes puisse être envisagée.
Le contrôle efficace de la diathèse ulcéreuse peptique par les moyens médicaux ou les interventions chirurgicales décrites permet d'affirmer que la cause principale de la mort des malades atteints du syndrome de Zollinger Ellison reléve de la progression inexorable du processus tumoral. Les progrés de la chimiothérapie et de la radiothérapie devraient apporter une solution á ce probléme dans un proche avenir.
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Harris, N.W.S., Osborne, D.H. & Carter, D.C. Management of the patient presenting as an emergency with hypergastrinemia. World J. Surg. 6, 710–717 (1982). https://doi.org/10.1007/BF01655363
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DOI: https://doi.org/10.1007/BF01655363