A 52-year-old man presents with recurrent peptic ulcer disease despite two courses of H. pylori eradication therapy and 8 weeks of high-dose PPI. Serum gastrin is 950 pg/mL and gastrin rises to 1100 pg/mL after secretin injection. CT abdomen is negative for a mass. Which is the most appropriate next step?
- A Endoscopic ultrasound (EUS) for localization ✓
- B Total gastrectomy
- C Empirical high-dose PPI and repeat CT in 6 months
- D Somatostatin receptor scintigraphy (Octreoscan) alone
Correct answer: A. Endoscopic ultrasound (EUS) for localization
Explanation
In Zollinger-Ellison syndrome with negative CT, EUS is the best next step to localize small duodenal or pancreatic gastrinomas. Somatostatin receptor scintigraphy has limited sensitivity for small duodenal lesions and is not definitive alone. Total gastrectomy is reserved for refractory, unlocalized disease after exhaustive imaging. High-dose PPI alone is not appropriate without localization.
Reference: Schwartz's Principles of Surgery, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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