Endoscopic diagnosis and removal of a duodenal wall gastrinoma.

A 54-year-old man presented with unrelenting abdominal pain. An upper gastrointestinal x-ray showed a gastric ulcer. The duodenum showed minimal cap deformity suggestive of antecedent ulcer disease. The upper small intestine was within normal limits. Gastroduodenoscopy revealed a duodenal polyp. Biopsy of the polyp identified the presence of a gastrinoma. Serum gastrin level before endoscopic polypectomy was 489 pg/ml. Endoscopic polypectomy was performed and electron micrographs of the tissue revealed endosecretory granules of the gastrinoma. Complete removal of the gastrinoma was suggested by comparative gastric analyses, by serum gastrin levels of 93, 180, and 167 pg/ml, and by the clinical course.