[Gastrinoma: diagnosis and management of Zollinger-Ellison syndrome].

Diagnosis and management of Zollinger-Ellison syndrome (ZES) do not appear to be established even today. In the present study, 143 cases of ZES (including 12 of author's experience) were collected from Japanese literature and analyzed, and diagnosis and management were discussed. (1) Although 43% of patients showed high gastrin level (greater than or equal to 500pg/ml), it is worth to be stressed that gastrin level was below 300pg/ml in 29% of patients. (2) Secretin provocation test was essential for diagnosis and particularly useful for detecting ZES with low gastrin level. (3) Angiography and/or blood samplings of PTPC were widely used for localizing gastrinoma but the informations thus obtained were not always of help for complete removal of tumors since malignant or multiple gastrinomas were frequent. (4) An aim of management for ZES consists of complete removal of tumor but it is not always feasible. Therefore, removal of target organ (total gastrectomy) should be routinely added for long-term cure. (5) Value of chemical gastrectomy (H2-receptor antagonist) is still a matter of pros and cons but substantial value of this drug should be considered adjunct to surgery.