Gastrinomas

The gastrinoma syndrome is characterized by gastric hypersecretion. The profound acid hypersecretion associated with gastrinomas typically causes abdominal pain due to peptic ulcer disease, diarrhea, and reflux esophagitis. Proton pump inhibitors are highly effective in controlling the symptoms associated with gastric hypersection. The localization and surgical resection of gastrinomas often present a greater challenge. The overwhelming majority of gastrinomas are found in the "gastrinoma triangle," an area bounded by the cystic and common bile ducts, the duodenum, and the pancreas. Within this area, tumors are most commonly found in the pancreas. Duodenal gastrinomas typically measure lass than 1 cm, making them virtually impossible to detect with standard preoperative imaging studies. Although newer imaging techniques such as endoscopic ultrasound and somatostatin scintigraphy appear to have some utility in the preopertive evaluation of patients with gastrinoma, intraoperative palpation and duodenotomy is often still required.

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