Sampling strategies for analysis of enterochromaffin-like cell changes in Zollinger-Ellison syndrome

To investigate the optimum number of biopsy specimens to be obtained for en terochromaffin-like (ECL) cell monitoring in hypergastrinemic patients and ECL cell regional variations potentially influencing the results, qualitati ve ECL cell changes were assessed in 149 patients with Zollinger-Ellison sy ndrome using jumbo biopsy specimens and a systematic sampling procedure of 4 areas each from the lesser or greater curvature of the gastric body. Of 1 ,176 specimens examined, 1,101 were adequate. The correlation was excellent between different sites within the greater or lesser curvature. In contras t, a normal ECL cell pattern was more frequent in the lesser curvature, whe reas linear hyperplasia was more frequent in the greater curvature. Dysplas tic lesions and carcinoid tumors in endoscopically unremarkable mucosa were detected in 3.4% and 1.2% of biopsy specimens, respectively, and were equa lly distributed between the lesser and greater curvature. Their chances of being diagnosed were related to the number of specimens examined Extensive sampling of both the lesser and greater curvature is recommended for early diagnosis of dysplastic and/or carcinoid lesions in patients at risk. In co ntrast, limited sampling in the greater curvature seems to be adequate in p atients with no risk for carcinoid development.