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Selective surgical management of correctable hypergastrinemia
R Delcore1, A S Hermreck, S R Friesen
1Department of Surgery, University of Kansas School of Medicine, Mo.
Surgery
|December 1, 1989
Summary
Surgical resection successfully treated hypergastrinemia in patients with antral G cell hyperplasia and duodenal or lymph node gastrinomas. Pancreatic gastrinomas and MEN I often led to metastases, with unidentified sources requiring gastrectomy.
Area of Science:
- Gastroenterology
- Endocrinology
- Surgical Oncology
Background:
- Hypergastrinemia, a condition of elevated gastrin levels, can stem from various sources including G cell hyperplasia and gastrinomas.
- Identifying the source of hypergastrinemia is crucial for determining appropriate surgical management and predicting patient outcomes.
- Surgical intervention aims to correct hypergastrinemia and prevent complications such as metastases.
Purpose of the Study:
- To evaluate the efficacy of surgical resection in managing different causes of hypergastrinemia.
- To analyze the long-term outcomes, including cure rates and metastasis development, following surgical treatment for hypergastrinemia.
- To provide recommendations for surgical strategies based on the identified source of hypergastrinemia.
Main Methods:
- Retrospective analysis of 60 patients with surgically correctable hypergastrinemia treated between 1960 and 1988.
- Utilized provocative testing for source localization when available.
- Categorized patients based on the source of hypergastrinemia: antral G cell hyperplasia (AGCH), pancreatic gastrinomas, duodenal gastrinomas, multiple endocrine neoplasia type I (MEN I) with gastrinomas, lymph node gastrinomas, and idiopathic cases.
Main Results:
- Complete resolution of hypergastrinemia (eugastrinemia) was achieved in all 17 patients with AGCH, 9 of 11 with duodenal gastrinomas, and 3 of 4 with lymph node gastrinomas.
- Surgical resection failed to cure hypergastrinemia in all 14 patients with pancreatic gastrinomas and all 5 with MEN I.
- Hepatic metastases developed in a significant proportion of patients with pancreatic gastrinomas (11/14) and MEN I (2/5).
- In patients with unidentified sources (9), 7 required total gastrectomy, and one developed hepatic metastases; antroduodenectomy was suggested as an alternative.
Conclusions:
- Resection is highly effective for AGCH, duodenal gastrinomas, and lymph node gastrinomas.
- Pancreatic gastrinomas, both sporadic and MEN I-associated, have poor surgical outcomes with frequent hepatic metastases.
- For unidentified hypergastrinemia sources, total gastrectomy or antroduodenectomy (to uncover occult tumors or treat AGCH) should be considered.