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Characteristics of duodenal wall gastrinomas
R Delcore1, L Y Cheung, S R Friesen
1Department of Surgery, University of Kansas Medical Center, Kansas City 66103.
American Journal of Surgery
|December 1, 1990
Summary
Surgical resection of duodenal wall gastrinomas (DWGs) is often curative for Zollinger-Ellison syndrome. Complete excision of single, small, submucosal DWGs in the proximal duodenum leads to successful outcomes.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Endocrinology
Background:
- Zollinger-Ellison syndrome (ZES) is characterized by hypergastrinemia and gastric acid hypersecretion due to gastrin-producing tumors.
- Duodenal wall gastrinomas (DWGs) are a specific subtype of neuroendocrine tumors causing ZES, often presenting as small, submucosal lesions.
- Diagnosis and management of DWGs are crucial for controlling ZES and preventing complications.
Purpose of the Study:
- To evaluate the clinical characteristics and surgical outcomes of patients with duodenal wall gastrinomas (DWGs) and Zollinger-Ellison syndrome (ZES).
- To assess the efficacy of surgical resection in achieving long-term biochemical cure (eugastrinemia) in patients with DWGs.
- To identify factors predicting successful surgical management and prognosis in this patient cohort.
Main Methods:
- Retrospective analysis of 15 patients diagnosed with duodenal wall gastrinomas (DWGs) and Zollinger-Ellison syndrome (ZES) treated since 1960.
- Review of surgical findings, histopathological examination of resected specimens, and assessment of lymph node metastasis.
- Evaluation of postoperative gastrin levels and patient follow-up duration to determine eugastrinemic status.
Main Results:
- Fifteen patients with duodenal wall gastrinomas (DWGs) and Zollinger-Ellison syndrome (ZES) were analyzed.
- DWGs were typically single (12/15), small (9/15 < 5 mm), submucosal, and located in the proximal duodenum (14/15).
- Complete surgical excision of single DWGs resulted in eugastrinemia in 9 of 12 patients (mean follow-up: 5.5 years); multiple DWGs did not achieve eugastrinemia postoperatively.
Conclusions:
- Duodenal wall gastrinomas (DWGs) are characteristically single, small, submucosal lesions in the proximal duodenum.
- Surgical resection of single DWGs offers a high chance of cure for Zollinger-Ellison syndrome (ZES).
- Multiple DWGs and lymph node metastases are associated with poorer outcomes and failure to achieve eugastrinemia.