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Gastric carcinoids. The Yale Experience
I M Modlin1, C J Gilligan, G P Lawton
1Department of Surgery, Yale University School of Medicine, West Haven, Conn.
Objectives:
To document our experience with gastric carcinoids over the past decade and to identify lesion frequency and the existence of a relationship to low acid states.
Design:
Retrospective case series.
Setting:
Tertiary care referral center.
Patients:
A consecutive sample of 16 patients with gastric carcinoids was evaluated over the last decade. Only two cases were recorded in the prior decade. Ages ranged from 30 to 93 years (mean, 65.9 years). There were eight men and eight women. Three patients were unavailable for follow-up.
Interventions:
Therapy included total gastrectomy (n = 4), subtotal gastrectomy (n = 3), endoscopic polypectomy (n = 3), and endoscopic surveillance (n = 6).
Main Outcome Measures:
Pathobiological tumor characteristics and survival.
Results:
All carcinoids were of gastric fundic origin. None of the patients exhibited the carcinoid syndrome. Chronic atrophic gastritis was the most frequently observed comorbid pathologic condition (63%). Half of the patients had multiple polypi. Mean follow-up was 4.7 years (n = 13). There were 10 survivors. The only related death occurred in a patient with a solitary tumor.
Conclusions:
Diagnosis of the complex and ill-defined entity of gastric carcinoid is increasing. This may be due to an increased awareness and increased upper gastrointestinal endoscopy rate rather than an increase in real incidence. Criteria for prediction of malignant progression are not available. Multiple gastric carcinoids associated with hypergastrinemia predominantly display nonaggressive behavior. Conservative gastric surgery may be appropriate therapy for such patients.