Figure 14-11. Examples of two regional localization studies for gastrinomas. In A, the illustration depicts the results of portal venous sampling for gastrin levels (numbers) in relation to the location of the gastrinoma at laparotomy (shaded area). A significant increase in gastrin is seen in the veins draining the head of the pancreas. IMV = inferior mesenteric vein; IPDV = inferior pancreaticoduodenal vein; PV = portal vein; SMV = superior mesenteric vein; SPDV = superior pancreaticoduodenal vein; SV = splenic vein. Numbers are in pg/mL. In B, an alternate regional localization approach involves selective arterial infusion of secretin into arteries supplying the pancreas and liver with measurement of concomitant hepatic vein gastrin levels. In this instance, a significant increase in hepatic vein gastrin levels is seen at around 70 seconds after injection of the superior mesenteric artery.

Time after injection (seconds)

may manifest itself as weight loss and malnutrition. In approximately 10% of patients, endoscopy shows evidence of lower esophageal inflammation, ulceration, or stricture if the reflux symptoms are long-standing.

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