Successful Surgical Plus Subsequent Endoscopic Treatment of Refractory Esophagostenosis due to Duodenal Gastrinoma

• Published in: Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 78; no. 4; pp. 721 - 726
• Main Authors: SHINMURA, Kazuki, NEMOTO, Hiroshi, OOIKE, Nobuyuki, HASHIMOTO, Toji, KATO, Takashi, TANAKA, Junichi
• Format: Journal Article
• Language: Japanese
• Published: Japan Surgical Association 2017
• Subjects: duodenal gastrinoma; refractory esophagostenosis; Zollinger–Ellison syndrome
• ISSN: 1345-2843; 1882-5133
• DOI: 10.3919/jjsa.78.721

Gastrinoma is a rare disease. We encountered a patient with perforative peritonitis and refractory esophagostenosis due to Zollinger-Ellison syndrome resulting from a duodenal gastrinoma. The patient was a 74-year-old man. He had been diagnosed with reflux esophagitis three years prior. Two repeated episodes of duodenal perforation developed despite ongoing treatment for reflux esophagitis, requiring twice surgeries. Circumferential narrowing of the lower esophagus ensued, and endoscopic balloon dilation (EBD) did not resolve the patient's symptoms. Contrast-enhanced computed tomography and SACI testing were performed, which led to a diagnosis of gastrinoma in the duodenal bulb. The patient was considered a poor candidate for esophagectomy with thoracotomy because he also had chronic obstructive pulmonary disease. Thus, we planned surgical and endoscopic treatment. The surgery consisted of duodenal bulb resection to remove the tumor, distal gastrectomy to decrease acid production, and Roux-Y reconstruction to reduce backflow of the duodenal juice into the esophagus. EBD was performed postoperatively to treat the esophageal stricture. This strategy proved successful for our poor risk patient ; he was able to resume oral intake. No relapse was noted three years postoperatively.