Zollinger Ellison syndrome (ZES) is rare entity characterized by recurrent peptic
ulcers due to high acid production from gastric parietal cells as a result of elevated
secretion of the hormone gastrin [
1
,
2
,
3
,
4
,
5
]. The abnormally high levels of gastrin are caused by a gastrin-secreting neuroendicrine
tumor (gastrinoma) that frequently develops from the pancreas or from the first or
second portion of the duodenum, in the denominated “gastrinoma triangle” [
2
,
3
,
4
,
5
]. Approximately 75% of ZES cases are sporadic, with the remaining 25% associated with
multiple endocrine neoplasm type 1 [
[1]
]. Approximately .1% of the patients with duodenal ulcers have evidence of ZES [
[1]
]. The reported incidence of gastrinoma has been .5–4/1 million of the population annually
[
[1]
]. The incidence of marginal ulceration after Roux-en-Y gastric bypass (RYGB) has been reported at .8–2.6% [
6
,
7
,
8
]. Although the incidence of ZES in bariatric patients is unknown, ZES has frequently
been considered in the differential diagnosis of a patient with refractory marginal
ulcers. To our knowledge, no reports have been published describing the diagnostic
algorithm and management of this infrequent, yet serious, condition in patients after
RYGB. We present a case of ZES that developed 7 years after RYGB. A gastrinoma was
suspected and identified. The patient underwent laparoscopic-assisted endoscopy and
endoscopic ultrasonography (EUS), and the tumor was successfully resected by laparoscopy.
The patient had an uneventful recovery.Keywords
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Article info
Publication history
Published online: September 01, 2010
Accepted:
June 8,
2010
Received:
May 25,
2010
Identification
Copyright
© 2010 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
