Role of endoscopic ultrasonography in screening and treatment of pancreatic endocrine tumours in asymptomatic patients with multiple endocrine neoplasia type 1

• Published in: British journal of surgery Vol. 90; no. 6; pp. 748 - 754
• Main Authors: Gauger, P. G., Scheiman, J. M., Wamsteker, E.-J., Richards, M. L., Doherty, G. M., Thompson, N. W.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.06.2003; Wiley
• Subjects: Adolescent; Adult; Biological and medical sciences; Digestive system. Abdomen; Endoscopy, Digestive System - methods; Endosonography - methods; Gastrins - blood; Humans; Investigative techniques, diagnostic techniques (general aspects); Linear Models; Medical sciences; Middle Aged; Multiple Endocrine Neoplasia Type 1 - diagnostic imaging; Multiple Endocrine Neoplasia Type 1 - surgery; Pancreatectomy - methods; Pancreatic Neoplasms - diagnostic imaging; Pancreatic Neoplasms - surgery; Prognosis; Retrospective Studies; Splenectomy - methods; Ultrasonic investigative techniques; Endocrinopathy; Sonography; Human; Hormone; Decision making; Peptide hormone; Exploration; Asymptomatic; Medical screening; Genetic disease; Multiple endocrine neoplasia type I; Gastrointestinal hormone; Treatment; Gastrin; Digestive diseases; Complication; Tumor; Benign neoplasm; Diagnosis; Endoscopy; Pancreatic disease; Endocrine pancreas
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.4142

Background: Patients with multiple endocrine neoplasia (MEN) type 1 risk premature death from pancreatic endocrine tumours (PETs). Endoscopic ultrasonography (EUS) is the most sensitive imaging modality for small PETs. A screening and therapeutic approach for asymptomatic patients is delineated in which EUS plays a pivotal role. Methods: This was a retrospective study of 15 patients with MEN‐1 but with no symptoms of a PET. All patients underwent serum hormone measurement, including gastrin, and EUS. The findings were used to facilitate operative treatment. Results: Six of 15 patients had a normal basal gastrin level and nine had a raised level. EUS demonstrated PETs in 14 patients and identified multiple lesions in 12. There was no predictive relationship between age or gastrin level and the number or size of PETs discovered. Thirteen patients have undergone enucleation or resection of PETs and two remain under observation. Nine of the 13 patients underwent transduodenal exploration to excise gastrinoma(s). One patient had lymph node metastases found at operation. There was no death. Self‐limiting pancreatic fistula in five patients and biliary fistula in one. Conclusion: Early and aggressive screening using EUS identifies PETs in asymptomatic patients with MEN‐1. Detection of tumours at an early stage, before the development of symptoms, lymph node metastases or liver metastases, may facilitate prompt surgical intervention and improve prognosis. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Endoscopic ultrasound helps to identify and resect MEN‐1 endocrine pancreatic tumours at an early stage