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Surgical management of Zollinger-Ellison syndrome: Classical considerations and current controversies.
World J Gastroenterol. 2019 Aug 28; 25(32):4673-4681.WJ

Abstract

Zollinger-Ellison syndrome (ZES) is characterized by gastric acid hypersecretion causing severe recurrent acid-related peptic disease. Excessive secretion of gastrin can now be effectively controlled with powerful proton pump inhibitors, but surgical management to control gastrinoma itself remains controversial. Based on a thorough literature review, we design a surgical algorithm for ZES and list some significant consensus findings and recommendations: (1) For sporadic ZES, surgery should be routinely undertaken as early as possible not only for patients with a precisely localized diagnosis but also for those with negative imaging findings. The surgical approach for sporadic ZES depends on the lesion location (including the duodenum, pancreas, lymph nodes, hepatobiliary tract, stomach, and some extremely rare sites such as the ovaries, heart, omentum, and jejunum). Intraoperative liver exploration and lymphadenectomy should be routinely performed; (2) For multiple endocrine neoplasia type 1-related ZES (MEN1/ZES), surgery should not be performed routinely except for lesions > 2 cm. An attempt to perform radical resection (pancreaticoduodenectomy followed by lymphadenectomy) can be made. The ameliorating effect of parathyroid surgery should be considered, and parathyroidectomy should be performed first before any abdominal surgery for ZES; and (3) For hepatic metastatic disease, hepatic resection should be routinely performed. Currently, liver transplantation is still considered an investigational therapeutic approach for ZES. Well-designed prospective studies are desperately needed to further verify and modify the current considerations.

Authors+Show Affiliations

Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100730, China.Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100730, China.Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100730, China.Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100730, China.Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing 100730, China. wwb_xh@163.com.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31528093

Citation

Shao, Qian-Qian, et al. "Surgical Management of Zollinger-Ellison Syndrome: Classical Considerations and Current Controversies." World Journal of Gastroenterology, vol. 25, no. 32, 2019, pp. 4673-4681.
Shao QQ, Zhao BB, Dong LB, et al. Surgical management of Zollinger-Ellison syndrome: Classical considerations and current controversies. World J Gastroenterol. 2019;25(32):4673-4681.
Shao, Q. Q., Zhao, B. B., Dong, L. B., Cao, H. T., & Wang, W. B. (2019). Surgical management of Zollinger-Ellison syndrome: Classical considerations and current controversies. World Journal of Gastroenterology, 25(32), 4673-4681. https://doi.org/10.3748/wjg.v25.i32.4673
Shao QQ, et al. Surgical Management of Zollinger-Ellison Syndrome: Classical Considerations and Current Controversies. World J Gastroenterol. 2019 Aug 28;25(32):4673-4681. PubMed PMID: 31528093.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical management of Zollinger-Ellison syndrome: Classical considerations and current controversies. AU - Shao,Qian-Qian, AU - Zhao,Bang-Bo, AU - Dong,Liang-Bo, AU - Cao,Hong-Tao, AU - Wang,Wei-Bin, PY - 2019/03/02/received PY - 2019/04/29/revised PY - 2019/05/03/accepted PY - 2019/9/19/entrez PY - 2019/9/19/pubmed PY - 2020/2/15/medline KW - Hepatic metastatic disease KW - Multiple endocrine neoplasia type 1 KW - Sporadic gastrinomas KW - Surgical treatment KW - Zollinger-Ellison syndrome SP - 4673 EP - 4681 JF - World journal of gastroenterology JO - World J. Gastroenterol. VL - 25 IS - 32 N2 - Zollinger-Ellison syndrome (ZES) is characterized by gastric acid hypersecretion causing severe recurrent acid-related peptic disease. Excessive secretion of gastrin can now be effectively controlled with powerful proton pump inhibitors, but surgical management to control gastrinoma itself remains controversial. Based on a thorough literature review, we design a surgical algorithm for ZES and list some significant consensus findings and recommendations: (1) For sporadic ZES, surgery should be routinely undertaken as early as possible not only for patients with a precisely localized diagnosis but also for those with negative imaging findings. The surgical approach for sporadic ZES depends on the lesion location (including the duodenum, pancreas, lymph nodes, hepatobiliary tract, stomach, and some extremely rare sites such as the ovaries, heart, omentum, and jejunum). Intraoperative liver exploration and lymphadenectomy should be routinely performed; (2) For multiple endocrine neoplasia type 1-related ZES (MEN1/ZES), surgery should not be performed routinely except for lesions > 2 cm. An attempt to perform radical resection (pancreaticoduodenectomy followed by lymphadenectomy) can be made. The ameliorating effect of parathyroid surgery should be considered, and parathyroidectomy should be performed first before any abdominal surgery for ZES; and (3) For hepatic metastatic disease, hepatic resection should be routinely performed. Currently, liver transplantation is still considered an investigational therapeutic approach for ZES. Well-designed prospective studies are desperately needed to further verify and modify the current considerations. SN - 2219-2840 UR - https://www.unboundmedicine.com/medline/citation/31528093/Surgical_management_of_Zollinger-Ellison_syndrome:_Classical_considerations_and_current_controversies L2 - https://www.wjgnet.com/1007-9327/full/v25/i32/4673.htm DB - PRIME DP - Unbound Medicine ER -