A PROSPECTIVE-STUDY OF INTRAOPERATIVE METHODS TO DIAGNOSE AND RESECT DUODENAL GASTRINOMAS

Objective This study determined, prospectively, whether duodenotomy (D X) should be routinely performed in explorations for patients with Zol linger-Ellison syndrome (ZES). Summary Background Data Duodenal gastri nomas are now being found with increasing frequency in patients with Z ollinger-Ellison syndrome. The surgical approach used to detect these tumors is controversial. Some recommend intraoperative endoscopy with transillumination (IOE) at surgery, while others recommend routine DX. Methods Beginning in 1989, the authors prospectively compared the abi lity of palpation, intraoperative ultrasound (IOUS), IOE, and DX (in t hat sequence) to detect gastrinomas in 35 consecutive patients with ZE S. Each patient also underwent preoperative localization studies. Resu lts Thirty-three of 35 patients (94%) had tumor detected and excised; duodenal gastrinomas were excised in 27 patients (77%). The average si ze of the duodenal tumors was 0.8 cm, significantly smaller (p < 0.005 ) than the pancreatic and lymph node tumors in this series. Standard p alpation after a Kocher maneuver identified 19 of the 31 duodenal tumo rs (61%) in the 27 patients. IOUS revealed only eight duodenal tumors (26%) and no new lesions. IOE identified 20 duodenal gastrinomas (64%) and 6 new lesions. DX identified 31 duodenal tumors (100%) and 5 addi tional tumors. The morbidity rate was 17%. One patient had a duodenal fistula after operation (2.8%) and subsequently recovered. No patient died. Conclusions These results demonstrate that the duodenum is the m ost common location for gastrinoma in patients with ZES (77%) and that DX to detect and remove duodenal gastrinomas should be routinely perf ormed in all explorations for patients with ZES.