Editing Zollinger-Ellison syndrome (section)

== '''Management''' ==

* Medical
** High-dose PPI
** Good for unresectable or      metastatic disease
* Surgical
** All patients with sporadic      gastrinoma but no unresectable mets should have an exploratory curative      laparotomy
*** If not localised       pre-operatively, explore the entire abdomen, from underside of diaphragm       to the pelvic floor, with particular attention to the liver, right       subhepatic and paraduodenal area, and pelvic cul-de-sac and ovaries, and       small bowel and colon. Perform intra-operative USS and check duodenum.
*** Excise regional nodes too -       aim for >10
** In more advanced disease,      cytoreductive surgery is worth considering. Can do stuff like ablation of      mets
* Radiotherapy
** Possibly useful in      palliative patients
* Chemotherapy
** Indications
*** Unresectable or recurrent       disease
** Somatostatin analogues      and/or a streptozocin/doxorubicin-based CTX regime
* Treatment of mets
** Consider liver-directed      therapies - RFA, cryoablation, embolisation, resection, or      transplantation
* Patients with MEN 1
** Parathyroidectomy should be      done prior to gastrinomaectomy
** In patients with MEN1 - only      resect if identifiable gastrinoma >2cm