Hypergastrinemia, Gastrinoma, and Multiple Endocrine Neoplasia 1

Conclusions

Gastrinomas occur sporadically in most instances, although 25% are associated with MEN 1. Complications of acid hypersecretion can be ameliorated with proton pump inhibitors, and gastrectomy is rarely necessary for hemorrhage. Most contend that surgery for MEN 1-associated gastrinomas should not be proposed routinely because of multicentric disease, high recurrence rates, and long-term survival regardless of treatment. Sporadic gastrinomas, however, should be considered for resection if imaging studies do not show a large volume or distant disease. Most gastrinomas can be localized. If operative maneuvers fail to identify the lesion, choices include closing without intervention, parietal cell vagotomy (if no ulcer-related complications have occurred) or total gastrectomy (for life-threatening ulcer-related complications).