The surgical treatment of the Zollinger-Ellison syndrome: an update.

Forty-six professors of surgery in answers to a questionnaire reported that 143 patients with Zollinger-Ellison syndrome had been admitted to their hospitals within the last 2 years. The bed capacity of these hospitals totaled 27,019. In extrapolating these figures, it is seen that the capacity of the 46 institutions averaged 587 beds per hospital, and that an average 71.5 patients with Zollinger-Ellison syndrome were admitted each year. In other words, a hospital with 587 beds might expect 1.55 yearly admissions of patients suffering from this disease. Two surgical methods have emerged as today's main treatment choices for Zollinger-Ellison syndrome that is unaccompanied by isolated gastrinoma. These are 1) preoperatively administered H2 blockers followed by less-than-total gastrectomy, truncal vagotomy, and postoperative H2-blocker therapy; and 2) preoperatively administered H2 blockers followed by highly selective vagotomy plus postoperative H2-blocker therapy. Only seven of 46 respondents still maintain that total gastrectomy should be carried out to cure the disease. All respondents advocate excision of an isolated gastrinoma as the treatment of choice if one is found at surgery.