Usefulness of Selective Arterial Secretin Injection Test for Localization of Gastrinoma in the Zollinger-Ellison Syndrome

Imamura, Masayuki; Takahashi, Kazuhisa; Adachi, Hideki; Minematsu, Souhei; Shimada, Yutaka; Naito, Mitsuru; Suzuki, Takashi; Tobe, Takayoshi; Azuma, Takeshi

doi:10.1097/00000658-198703000-00003

Cited by 177 publications

(153 citation statements)

References 12 publications

Supporting

Mentioning

151

Contrasting

Unclassified

Order By: Relevance

“…Recently, it was noted that selective intraarterial calcium injection could be used to localize occult insulinoma (1,(16)(17)(18). The technique is based upon the use of intraarterial secretin injections for the localization of gastrinomas ( 19). Secretin is accepted as the most effective stimulant of gastrin release and is the first choice of an intraarterial stimulation in patients with Zollinger-Ellison syndrome.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of the Combination of Pre- and Intraoperative Selective Intraarterial Calcium Injection to Detect Residual Insulinomas.

et al. 2001

View full text Add to dashboard Cite

In a 35-year-old womandiagnosed with insulinoma selective intraarterial calcium injection was positive for proximal gastroduodenal artery and inferior pancreaticoduodenal artery involvement preoperatively. Although non-invasive imaging studies were negative, a mass was detected at the pancreatic uncus by intraoperative ultrasonography. Gastroduodenal artery calcium injection was performed after enucleation of the tumor. Following calcium injection, the insulin level was inappropriately increased and further pancreaticoduodenectomy was performed. After excision, another tumor was detected at the head of the pancreas by histopathological examination. As shown, selective intraarterial calcium injection is useful to localize tumors preoperatively and intraoperatively. (Internal Medicine 40: 48-51, 2001) Key words: gastroduodenal artery, enucleation, pancreaticoduodenectomy,another adenoma Case ReportA 35-year-old Japanese female had episodes of loss of awareness over 10 months. She had had a traffic accident while driving alone and was brought to our hospital on May 13, 1997. Family and past histories were not remarkable. The patient weighed 57.0 kg and her body height was 158 cm (body mass index; 22.8 kg/m2). The level of consciousness was E1V2M5(by Glasgow ComaScale). Results of routine laboratory tests including blood chemistry, hemogram, and serology were normal except for a plasma glucose of 27 mg/dl (70-110 mg/dl) and an immunoreactive insulin (IRI) of 8.7 jiU/ml (0-17 |llU/ ml). Anti-insulin antibody and anti-insulin receptor antibody tests were negative. Continuous intravenous injection of 10% glucose was given to maintain a plasma glucose level of over 70 mg/dl in order to prevent hypoglycemia and associated symptoms. Then, a fasting glucose tolerance test was performed. Based upon the collected data, the biochemical criteria for the diagnosis of insulinoma were met. Namely, the patient had symptomatic hypoglycemia (plasma glucose 47 mg/ dl) with inappropriately elevated IRI (1 1 |iU/ml) (0-17 |LiU/ ml) and C-peptide (2.2 ng/ml) (0.6-2.8 ng/ml) after 6 hours. Serum levels of HCGand HCG-pwere normal. Function of the pituitary, adrenal, thyroid, and parathyroid glands were normal. Ultrasonography (US), endoscopic ultrasonography (EUS), computed tomography (CT), magnetic resonance imaging, digital subtraction angiography, and CT angiography failed to localize the tumors. There was no evidence of hepatic metastasis on CT scan or by angiography. The percutaneous transhepatic venous sampling (PTVS) was also negative. Finally, selective intraarterial calcium injection was performed. We used the method described by O'shea et al (1). A catheter was placed in the right hepatic vein close to its junction with the inferior vena cava via a femoral vein. Each artery [proximal gastroduodenal artery (GDA), inferior pancreatico-duodenal artery (IPDA), proximal splenic artery, left hepatic artery, superior mesenteric artery] was catheterized in turn. After samples were taken twice from the hepatic vein as contr...

show abstract

Section: Discussionmentioning

confidence: 99%

Usefulness of the Combination of Pre- and Intraoperative Selective Intraarterial Calcium Injection to Detect Residual Insulinomas.

et al. 2001

View full text Add to dashboard Cite

show abstract

“…26 These imaging techniques cannot be relied on for curative resection of gastrinomas. 2,12,13 Similarly, portal venous sampling (PVS) has not predicted the precise location of gastrinomas, and its accuracy rate has been described to be between 30% and 70%. 4,14 A new technique, the selective arterial secretagogue injection test (SASI test) with secretin or calcium and somatostatin receptor scintigraphy (SRS) represents the most reliable approach to localizing gastrinomas.…”

Section: Localizationmentioning

confidence: 99%

“…4,14 A new technique, the selective arterial secretagogue injection test (SASI test) with secretin or calcium and somatostatin receptor scintigraphy (SRS) represents the most reliable approach to localizing gastrinomas. [2][3][4][12][13][14][15][16][17][18][19][20] The guiding principle of the SASI test is localization of gastrinomas by demonstrating a feeding artery of the gastrinoma. This works because gastrinoma cells release gastrin when stimulated with secretin or calcium, both in vitro and in vivo.…”

Section: Localizationmentioning

confidence: 99%

“…6,9,10 In 80% of patients with sporadic duodenal gastrinoma, resection of a single duodenal gastrinoma with dissection of the regional lymph nodes has been sufficient for cure; in the other 20% of these patients, either there are multiple duodenal gastrinomas or a combination of duodenal and pancreatic gastrinomas. 2 …”

Section: Surgery For Gastrinomas In Patients Without Men-1 (Sporadic mentioning

confidence: 99%

“…18 But some aggressive surgeons performed PD and achieved a high rate of curability with low morbidity. 2,3,[7][8][9][10][11][12]17 The experience with PD taught us how difficult was it to find duodenal gastrinomas and metastatic lymph nodes even at operation. But because only the microscopic duodenal gastrinomas had been revealed in the resected specimen only after the PD, we changed our strategy from PD to the transduodenal enucleation of the duodenal gastrinomas.…”

Section: When the Sasi Test Localizes Gastrinomas In The Head Of The mentioning

confidence: 99%

See 2 more Smart Citations

Changing Treatment Strategy for Gastrinoma in Patients with Zollinger‐Ellison Syndrome

Imamura

Komoto²,

Ota³

2005

World j. surg.

Self Cite

View full text Add to dashboard Cite

We overviewed the recent development of curative surgery for gastrinoma that has been rapidly improved since the development of new localization techniques, especially the selective arterial secretagogue injection test (SASI test) and somatostatin receptor scintigraphy (SRS). A number of new pathological findings of gastrinomas in patients with Zollinger-Ellison syndrome have been accumulated in accordance with the increase of curative resection of gastrinomas, and these new findings also have contributed to the progress of the treatment strategy for grastrinomas.U ntil recently, medical treatment with a proton pump inhibitor or an H2 blocker has been the treatment of choice for patients with Zollinger-Ellison syndrome (ZES) because of the difficulty in accomplishing curative resection of gastrinomas, which are often metastatic and multiple. Symptoms of ZES, such as persistent peptic ulcer, regurgitation esophagitis, or diarrhea, appear even when the gastrinoma is too small to be recognized with computed tomography (CT) or magnetic resonance imaging (MRI), 1-12 and localization of small functioning gastropancreatic-endocrine tumors (GEPET) has been unsuccessful. [1][2][3][4] All gastrinomas are potentially metastatic. Liver metastases are the significant prognostic factor in patients with gastrinoma, and only R0 resection can achieve a disease-free survival. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] For all of these reasons, curative resection of gastrinomas guided by an accurate localization technique has long been awaited. Such a technique has been realized with the development of the selective arterial secretagogue injection test (SASI test) with secretin or calcium and somatostatin receptor scintigraphy (SRS). 2-6,14-17 Increased curative resection surgery for gastrinomas in patients with ZES has elucidated several important findings.In patients with ZES without multiple endocrine neoplasia type 1 (MEN-1), gastrinoma is located in either the duodenum or the pancreas. In either location, gastrinomas are often single, but occasionally they co-exist. In the most recent reports, duodenal gastrioma is reported more frequently than pancreatic gastrinoma. [2][3][4][5][6][7][8][9][10][11][12] In patients with ZES and MEN-1, gastrinoma is located mostly in the duodenum, although there are numerous endocrine tumors in the pancreas. In about a half of these patients, multiple duodenal gastrinomas are diffusely located in the duodenum and sometimes they are numerous. 6,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Incidence of lymph node metastases in patients with either duodenal or pancreatic gastrinomas has been reported to be greater than 40%. [19][20][21][22][23][24][25][26][27] The incidence of hepatic metastases has been reported to be more than 60% in patients with the pancreatic gastrinoma, although it has consistently been less than 10% in patients with duodenal gastrinoma. 11,[22][23][24][25][26][27] Liver metastases are a significant prognostic factor in patients with...

show abstract

Localization and Resection of Insulinomas and Gastrinomas

Fraker

Norton²

1988

JAMA

View full text Add to dashboard Cite

A 45-YEAR-OLD woman with a threeyear history of epigastric pain was treated initially with cimetidine and then with ranitidine hydrochloride and antacids, with only mild relief. Her fasting serum gastrin level was elevated at 496 ng/L (496 pg/mL) (normal, <100 ng/L [<100 pg/mL]). Her basal acid output was 32 mEq/h (normal, <15 mEq/h). The results of her secretin stimulation test were abnormal, with a rise in the serum gastrin level from 239 ng/L (239 pg/mL) at baseline to 825 ng/L (825 pg/mL) (abnormal increment, >200 ng/L [>200 pg/mL]). Ultrasound, computed tomographic (CT) scan, and selective angiogram all failed to demonstrate a gastrinoma. Selective venous sampling was performed and a marked step-up in gastrin levels was found in the superior pancreaticoduodenal vein (Fig 1). The patient underwent an exploratory laparotomy, and intraoperative ultrasound demonstrated a lesion in the posterior head of the pancreas (Fig 2). After enucleation, this lesion was shown to be an islet cell tumor consistent with gastrinoma. The patient is asymptomatic, with normal fasting gas¬ trin concentrations and normal secretin stimulation test results 18 months after surgery. CASE 2A 39-year-old woman had noted epi¬ sodes of light-headedness for several From the Surgical Metabolism Section, Surgery Branch,

show abstract

Usefulness of Selective Arterial Secretin Injection Test for Localization of Gastrinoma in the Zollinger-Ellison Syndrome

Cited by 177 publications

References 12 publications

Usefulness of the Combination of Pre- and Intraoperative Selective Intraarterial Calcium Injection to Detect Residual Insulinomas.

Usefulness of the Combination of Pre- and Intraoperative Selective Intraarterial Calcium Injection to Detect Residual Insulinomas.

Changing Treatment Strategy for Gastrinoma in Patients with Zollinger‐Ellison Syndrome

Localization and Resection of Insulinomas and Gastrinomas

Contact Info

Product

Resources

About