GASTRIC CARCINOIDS - THE YALE EXPERIENCE

Objectives: To document our experience with gastric carcinoids over th e past decade and to identify lesion frequency and the existence of a relationship to low acid states. Design: Retrospective case series. Se tting: Tertiary care referral center. Patients: A consecutive sample o f 16 patients with gastric carcinoids was evaluated over the first dec ade. Only two cases were recorded in the prior decade. Ages ranged fro m 30 to 93 years (mean, 65.9 years). There were eight men and eight wo men. Three patients were unavailable for follow-up. Interventions: The rapy included total gastrectomy (n=4), subtotal gastrectomy (n=3), end oscopic polypectomy (n=3), and endoscopic surveillance (n=6). Main Out come Measures: Pathobiological tumor characteristics and survival. Res ults: All carcinoids were of gastric fundic origin. None of the patien ts exhibited the carcinoid syndrome. Chronic atrophic gastritis was th e most frequently observed comorbid pathologic condition (63%). Half o f 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 patie nt with a solitary tumor. Conclusions: Diagnosis of the complex and il l-defined entity of gastric carcinoid is increasing. This may be due t o an increased awareness and increased upper gastrointestinal endoscop y rate rather than an increase in real incidence. Criteria for predict ion of malignant progression are not available. Multiple gastric carci noids associated with hypergastrinemia predominantly display nonaggres sive behavior. Conservative gastric surgery may be appropriate therapy for such patients.