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Background & Aims: Risk factors of metachronous liver metastases and death are not well known in patients with the Zollinger–Ellison syndrome and multiple endocrine neoplasia type 1. These factors were retrospectively determined in 77 patients. Methods: Data chart review was performed. Results: Median follow-up was 102 months (range, 12–366). Surgery was performed on 48 patients, including 9 of the 10 patients with large pancreatic tumors (≥3 cm). Liver metastases developed in 4 patients (40%) with large pancreatic tumors, in 3 (4.8%) without, and in 1 of the 4 patients with pancreatic tumors of unknown size; all had previously undergone surgery. The only independent factor associated with development of liver metastases identified by multivariate analysis was large pancreatic tumors (risk ratio, 29.0; 95% confidence interval [CI], 3.2–260.7). Surgery was not selected. The probability of being free of liver metastases in the 63 patients without large pancreatic tumors was 96% (95% CI, 88–100) at 10 and 15 years. Thirteen (16.9%) patients died. The only independent factors of death selected by multivariate analysis were Zollinger–Ellison syndrome diagnosis before 1980 (risk ratio, 8.2; 95% CI, 1.7–40.6) and age at diagnosis (risk ratio/year, 1.08; 95% CI, 1.03–1.14). Conclusions: Large pancreatic tumors are predictive of the development of metachronous liver metastases, and surgery does not seem to prevent them. GASTROENTEROLOGY 1999;116:286-293

BACKGROUND & AIMS: Duodenal gastrinomas and peripancreatic lymph nodes are difficult to localize. The aim of this study was to evaluate the ability of Octreoscan scintigraphy to detect such tumors. METHODS: Results of Octreoscan scintigraphy in 21 consecutive patients with Zollinger-Ellison syndrome were compared with those of conventional imaging techniques, including endoscopic ultrasonography, and with the surgical findings. RESULTS: Surgical exploration found 27 duodenal and/or lymph node gastrinomas in 19 patients. None had pancreatic gastrinoma. Octreoscan scintigraphy was the only positive preoperative technique in 32% of the patients. The sensitivities of conventional techniques, Octreoscan scintigraphy, and their association were 58%, 58%, and 90%, respectively, for all resected gastrinomas. The smallest duodenal gastrinoma detected by Octreoscan scintigraphy measured 3 mm. Endoscopic ultrasonography detected all the tumors visualized by any other conventional technique and was considered falsely positive, as was Octreoscan scintigraphy, in 1 patient. Follow-up and comparison between the number of resected gastrinomas and the number of preoperative hot spots suggested that surgeons should find at least as many tumors as the number of hot spots. CONCLUSIONS: Octreoscan scintigraphy improved the preoperative detection of extrapancreatic gastrinomas, mainly by endoscopic ultrasonography. Surgeons should find at least as many gastrinomas as the number of hot spots. (Gastroenterology 1996 Oct;111(4):845-54)