A patient with Zollinger-Ellison syndrome (ZES) due to a solitary gastrinoma has a serum gastrin of 850 pg/mL (normal <100). The secretin stimulation test shows an increase of >200 pg/mL above baseline. Imaging localizes a 1.5 cm duodenal wall tumor. What is the most appropriate management?
- A Life-long proton pump inhibitor therapy without surgery
- B Surgical resection of the gastrinoma with duodenotomy if needed ✓
- C Total gastrectomy to eliminate acid production
- D Somatostatin analog (octreotide) therapy alone
Correct answer: B. Surgical resection of the gastrinoma with duodenotomy if needed
Explanation
In sporadic ZES with a localized, resectable gastrinoma (no MEN1, no liver metastases, tumor <2 cm), surgical resection is the treatment of choice as it offers the only potential cure, with 10-year disease-free survival rates of 30–40%. Duodenal gastrinomas, which account for up to 70% of sporadic ZES, require careful exploration including duodenotomy to identify small intramural tumors. PPIs control acid hypersecretion but do not address tumor growth or metastasis.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.