eMedicine Specialties > Gastroenterology > Stomach

Gastrinoma: Follow-up

Author: Jennifer Lynn Bonheur, MD, Attending Physician, Division of Gastroenterology, Lenox Hill Hospital
Coauthor(s): Senthil Nachimuthu, MD, FACP, Fellow in Cardiology, Heart and Vascular Institute, Tulane University School of Medicine
Contributor Information and Disclosures

Updated: Aug 29, 2009

Follow-up

Further Outpatient Care

  • Follow-up of patients with gastrinomas that have been resected is directed at the diagnosis and treatment of recurrence.
    • Measurement of the fasting serum gastrin level is the best screening test to monitor these patients.
    • Disease recurrence might present as a recurrent peptic ulceration, diarrhea, or abdominal pain.
    • If recurrent disease is identified, reoperation may be considered and undertaken if no evidence of metastasis exists.
    • Metastatic disease can be managed with chemotherapy and long-term acid suppression.

Prognosis

  • The primary determinants of survival for patients with gastrinomas are the size of the primary tumor and the development of tumor metastasis.
    • Patients with hepatic metastases may have a remaining life span of less than 1 year.
    • In patients with liver metastasis, the 5-year survival rate is 20-30%.
    • In patients with localized disease or metastasis to local lymph nodes without liver metastasis, the 5-year survival rate may be 90%.
  • Surgical resection of localized disease leads to a complete cure without any recurrence in 20-25% of patients with gastrinomas.

Miscellaneous

Medicolegal Pitfalls

  • Gastrinoma can be a difficult diagnosis. However, delay in diagnosis or misdiagnosis can lead to incorrect treatment or less successful treatment secondary to any such delay. Thus, gastrinoma always should be included in the differential diagnosis in those patients with the appropriate symptoms (see Clinical).
  • Risks exist regarding medication-induced adverse effects and the surgical procedures associated with the treatment of this disease.
 


More on Gastrinoma

Overview: Gastrinoma
Differential Diagnoses & Workup: Gastrinoma
Treatment & Medication: Gastrinoma
Follow-up: Gastrinoma
References
Further Reading
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References

  1. Ruiz-Tovar J, Priego P, Martinez-Molina E, et al. Pancreatic neuroendocrine tumours. Clin Transl Oncol. Aug 2008;10(8):493-7. [Medline].

  2. Kohan E, Oh D, Wang H, et al. Duodenal bulb mucosa with hypertrophic gastric oxyntic heterotopia in patients with Zollinger Ellison syndrome. Diagn Ther Endosc. 2009;2009:298381. [Medline]. [Full Text].

  3. Granberg D, Jacobsson H, Oberg K, Gustavsson J, Lehtihet M. Regression of a large malignant gastrinoma on treatment with Sandostatin LAR: a case report. Digestion. 2008;77(2):92-5. [Medline].

  4. Campana D, Piscitelli L, Mazzotta E. Zollinger-Ellison syndrome. Diagnosis and therapy. Minerva Med. Jun 2005;96(3):187-206. [Medline].

  5. Del Valle J, Scheiman J. Zollinger-Ellison Syndrome. Textbook of Gastroenterology, 4th Edition. 2003;1377-1388.

  6. Delvalle J, Yamada T. Zollinger-Ellison Syndrome. Textbook of Gastroenterology. 1995;1430.

  7. Feldman M, Sleisenger MW, McGuigan JE. Zollinger-Ellison syndrome and other hypersecretory states. In: Feldman M, Scharschmidt BF, Sleisenger M, Zorab R, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 6th ed. Philadelphia, Pa: WB Saunders; 1998:. 679-90.

  8. Hirschowitz BI. Zollinger-Ellison syndrome: pathogenesis, diagnosis, and management. Am J Gastroenterol. Apr 1997;92(4 Suppl):44S-48S; discussion 49S-50S. [Medline].

  9. Jensen RT, Gibril F. Somatostatin receptor scintigraphy in gastrinomas. Ital J Gastroenterol Hepatol. Oct 1999;31 Suppl 2:S179-85. [Medline].

  10. Mignon M, Cadiot G. Natural history of gastrinoma: lessons from the past. Ital J Gastroenterol Hepatol. Oct 1999;31 Suppl 2:S98-103. [Medline].

  11. Nobels FR, Kwekkeboom DJ, Coopmans W. Chromogranin A as serum marker for neuroendocrine neoplasia: comparison with neuron-specific enolase and the alpha-subunit of glycoprotein hormones. J Clin Endocrinol Metab. Aug 1997;82(8):2622-8. [Medline].

  12. Norton JA. Gastrinoma: advances in localization and treatment. Surg Oncol Clin N Am. Oct 1998;7(4):845-61. [Medline].

  13. Norton JA. Surgical treatment and prognosis of gastrinoma. Best Pract Res Clin Gastroenterol. Oct 2005;19(5):799-805. [Medline].

  14. Norton JA, Fang TD, Jensen RT. Surgery for gastrinoma and insulinoma in multiple endocrine neoplasia type 1. J Natl Compr Canc Netw. Feb 2006;4(2):148-53.

  15. Oberg K, Eriksson B. Endocrine tumours of the pancreas. Best Pract Res Clin Gastroenterol. Oct 2005;19(5):753-81.

  16. Passaro E, Howard TJ, Sawicki MP. The origin of sporadic gastrinomas within the gastrinoma triangle: a theory. Arch Surg. Jan 1998;133(1):13-6; discussion 17. [Medline].

  17. Pellicano R, De Angelis C, Resegotti A. Zollinger-Ellison syndrome in 2006: concepts from a clinical point of view. Panminerva Med. Mar 2006;48(1):33-40.

  18. Price TN, Thompson GB, Lewis JT, Lloyd RV, Young WF. Zollinger-Ellison syndrome due to primary gastrinoma of the extrahepatic biliary tree: three case reports and review of the literature. Endocr Pract. Jun 2 2009;1-38. [Medline].

  19. Sugg SL, Norton JA, Fraker DL. A prospective study of intraoperative methods to diagnose and resect duodenal gastrinomas. Ann Surg. Aug 1993;218(2):138-44. [Medline].

  20. Wong H, Yau T, Chan P, et al. PPI-delayed diagnosis of gastrinoma: oncologic victim of pharmacologic success. Pathol Oncol Res. Aug 20 2009;[Medline].

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Further Reading

Related eMedicine Topics

Clinical Trials

National Guideline Clearinghouse

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Keywords

gastrinoma, Zollinger-Ellison syndrome, ZES, ZE syndrome, pancreatic tumor, pancreas tumor, duodenal tumor, duodenal wall tumor, lymph node tumor, gastrin-secreting tumor, tumor, pancreatic islet cell tumors, malignancy, malignant tumor, basal acid output, BAO, ulcer, severe ulcer disease, multiple endocrine neoplasia type I, MEN type I, ulcerogenic islet cell tumor

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Contributor Information and Disclosures

Author

Jennifer Lynn Bonheur, MD, Attending Physician, Division of Gastroenterology, Lenox Hill Hospital
Jennifer Lynn Bonheur, MD is a member of the following medical societies: American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, New York Academy of Sciences, New York Society for Gastrointestinal Endoscopy, and Sigma Xi
Disclosure: Nothing to disclose.

Coauthor(s)

Senthil Nachimuthu, MD, FACP, Fellow in Cardiology, Heart and Vascular Institute, Tulane University School of Medicine
Senthil Nachimuthu, MD, FACP is a member of the following medical societies: American College of Physicians
Disclosure: Nothing to disclose.

Medical Editor

Manoop S Bhutani, MD, FACG, FACP, Professor, Department of Medicine, Division of Gastroenterology, Director, Center for Endoscopic Ultrasound, Co-Director, Center for Endoscopic Research, Training and Innovation, University of Texas Medical Branch at Galveston
Manoop S Bhutani, MD, FACG, FACP is a member of the following medical societies: American Association for the Advancement of Science, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Institute of Ultrasound in Medicine, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Simmy Bank, MD, Chair, Professor, Department of Internal Medicine, Division of Gastroenterology, Long Island Jewish Hospital, Albert Einstein College of Medicine
Disclosure: Nothing to disclose.

CME Editor

Rajalaxmi McKenna, MD, FACP, Consulting Staff, Department of Medicine, Southwest Medical Consultants, SC, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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