Síndrome de Zollinger-Ellison: revisión del conocimiento actual
DOI:
https://doi.org/10.30944/20117582.292Palabras clave:
síndrome de Zollinger-Ellison, gastrinoma, gastrinas, neoplasia endocrina múltiple, úlcera pépticaResumen
El síndrome de Zollinger-Ellison se caracteriza por la presencia de úlceras pépticas resistentes al tratamiento que se deben a la hipersecreción ectópica de gastrina por un tumor neuroendocrino, que es el gastrinoma y que resulta en la hipersecreción de ácido clorhídrico en el estómago. Este síndrome se presenta en forma esporádica y también se asocia al síndrome de neoplasia neuroendocrina múltiple de tipo 1. Se describen ambas presentaciones clínicas, así como también la fisiopatología, el diagnóstico, el estudio, el tratamiento y el pronóstico, enfatizando en los detalles técnicos de la cirugía. El pronóstico de los gastrinomas cuando son identificados precozmente es bueno, aun en aquellos casos malignos, por lo que la sospecha clínica asociada al estudio específico y al tratamiento de estos pacientes es fundamental. Dada la tecnología diagnóstica disponible en la actualidad, la identificación de estos tumores será cada vez más frecuente, por lo que el conocimiento de los detalles esenciales para su tratamiento es importante para el cirujano.
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Referencias bibliográficas
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https://doi.org/10.1097/00000658-195510000-00015
2. Kent RB, van Heerden JA, Weiland LH. Nonfunctioning islet cell tumors. Ann Surg. 1981;193:185-90.
https://doi.org/10.1097/00000658-198102000-00010
3. Stabile BE, Morrow DJ, Passaro E. The gastrinoma triangle: Operative implications. Am J Surg. 1984;147:25-31.
https://doi.org/10.1016/0002-9610(84)90029-1
4. Norton JA, Alexander HR, Fraker DL, Venzon DJ, Gibril F, Jensen RT. Possibly primary lymph node gastrinoma: Occurrence, natural history, and predictive factors. Ann Surg. 2003;237:650-9.
https://doi.org/10.1097/01.SLA.0000064375.51939.48
5. Klöppel G, Clemens A. The biological relevance of gastric neuroendocrine tumors. Yale J Biol Med. 1996;69:69-74.
6. Hirschowitz BI. Pathobiology and management of hypergastrinemia and the Zollinger-Ellison syndrome. Yale J Biol Med. 1992;65:659-76.
7. Metz DC, Jensen RT. Gastrointestinal neuroendocrine tumors: Pancreatic endocrine tumors. Gastroenterology. 2008;135:1469-92.
https://doi.org/10.1053/j.gastro.2008.05.047
8. Osefo N, Ito T, Jensen RT. Gastric acid hypersecretory states: Recent insights and advances. Curr Gastroenterol Rep. 2009;11:433-41.
https://doi.org/10.1007/s11894-009-0067-6
9. Jensen RT, Berna MJ, Bingham DB, Norton JA. Inherited pancreatic endocrine tumor syndromes: Advances in molecular pathogenesis, diagnosis, management, and controversies. Cancer. 2008;113(Suppl.):1807-43.
https://doi.org/10.1002/cncr.23648
10. Bordi C, D'Adda T, Azzoni C, Ferraro G. Pathogenesis of ECL tumors in humans. Yale J Biol Med. 1998;71:273-84.
11. Waldum HL, Brenna E, Sandvik AK. Relationship of ECL cells and gastric neoplasia. Yale J Biol Med. 1998;71:325-35.
12. Burkitt MD, Varro A, Pritchard DM. Importance of gastrin in the pathogenesis and treatment of gastric tumors. World J Gastroenterol. 2009;15:1-16.
https://doi.org/10.3748/wjg.15.1
13. Doherty GM, Olson JA, Frisella MM, Lairmore TC, Wells SA, Norton JA. Lethality of multiple endocrine neoplasia type 1. World J Surg. 1998; 22:581-7.
https://doi.org/10.1007/s002689900438
14. Veldhuis JD, Norton JA, Wells SA, Vinik AI, Perry RR. Surgical versus medical management of multiple endocrine neoplasia (MEN) type 1. J Clin Endocrinol Metab. 1997;82:357-64.
https://doi.org/10.1210/jcem.82.2.3711-1
15. Lopez CL, Waldmann J, Fendrich V, Langer P, Kann PH, Bartsch DK. Long-term results of surgery for pancreatic neuroendocrine neoplasms in patients with MEN-1. Langenbecks Arch Surg. 2011;396:1187-96.
https://doi.org/10.1007/s00423-011-0828-1
16. Jkerström G, Stjlberg P, Hellman P. Surgical management of pancreatic-duodenal tumors in multiple endocrine neoplasia syndrome type 1. Clinics. 2012;67:173-8.
https://doi.org/10.6061/clinics/2012(Sup01)29
17. Wolfe MM, Jensen RT. Zollinger-Ellison syndrome - Current concepts in diagnosis and management. N Engl J Med. 1987;317:1200-9.
https://doi.org/10.1056/NEJM198711053171907
18. Feldman M, Schiller LR, Walsh JH, Fordtran JS, Richardson CT. Positive intravenous secretin test in patients with achlorhydria-related hypergastrinemia. Gastroenterology. 1987;93: 59-62.
https://doi.org/10.1016/0016-5085(87)90314-3
19. Andersen DK. Current diagnosis and management of ZollingerEllison syndrome. Ann Surg. 1989;210:685-703.
https://doi.org/10.1097/00000658-198912000-00001
20. Ito T, Cadiot G, Jensen RT. Diagnosis of Zollinger-Ellison syndrome: Increasingly difficult. World J Gastroenterol. 2012;18:5495-503.
https://doi.org/10.3748/wjg.v18.i39.5495
21. Rehfeld JF, Gingras MH, Bardram L, Hilsted L, Goetze JP, Poitras P. The Zollinger-Ellison syndrome and mismeasurements of gastrin. Gastroenterology. 2011;140:1444-53.
https://doi.org/10.1053/j.gastro.2011.01.051
22. Poitras P, Gingras MH, Rehfeld JF. The Zollinger-Ellison syndrome: Dangers and consequences of interrupting antisecretory treatment. Clin Gastroenterol Hepatol. 2012;10:199-202.
https://doi.org/10.1016/j.cgh.2011.08.012
23. Alexander HR, Fraker DL, Norton JA, Barlett DL, Tio L, Benjamin SB, et al. Prospective study of somatostatin receptor scintigraphy and its effect on operative outcome in patients with Zollinger-Ellison syndrome. Ann Surg. 1998;228:228-38.
https://doi.org/10.1097/00000658-199808000-00013
24. Gibril F, Reynolds JC, Lubensky IA, Roy PK, Peghini PL, Doppman JL, et al. Ability of somatostatin receptor scintigraphy to identify patients with gastric carcinoids: A prospective study. J Nucl Med. 2000;41:1646-56.
25. Levy AD, Sobin LH. Gastrointestinal carcinoids: Imaging features with clinicopathologic comparison. Radio Graphics. 2007;27:237-57.
https://doi.org/10.1148/rg.271065169
26. Sugg SL, Norton JA, Fraker DL, Metz DC, Pisegna JR, Fishbeyn V, et al. A prospective study of intraoperative methods to diagnose and resect duodenal gastrinomas. Ann Surg. 1993;218:138-44.
https://doi.org/10.1097/00000658-199308000-00004
27. Thompson NW, Vinik AI, Eckhauser FE. Microgastrinomas of the duodenum: A cause of failed operations for the ZollingerEllison syndrome. Ann Surg. 1989;209:396-404.
https://doi.org/10.1097/00000658-198904000-00002
28. McCarthy DM. The place of surgery in the Zollinger-Ellison syndrome. N Engl J Med. 1980;302:1344-47.
https://doi.org/10.1056/NEJM198006123022404
29. Harmon JW, Norton JA, Collin MJ, Krudy AG, Shawker TH, Doppman JL, et al. Removal of gastrinomas for control of Zollinger-Ellison syndrome. Ann Surg. 1984;200:396-403.
https://doi.org/10.1097/00000658-198410000-00002
30. Thomson AB, Sauve MD, Kassam N, Kamitakahara H. Safety of the long-term use of proton pump inhibitors. World J Gastroenterol. 2010;16:2323-30.
https://doi.org/10.3748/wjg.v16.i19.2323
31. Norton JA, Fraker DL, Alexander R, Venzon DJ, Doppman JL, Serrano J, et al. Surgery to cure the Zollinger-Ellison syndrome. N Engl J Med. 1999;341:635-44.
https://doi.org/10.1056/NEJM199908263410902
32. Laimore TC, Chen VY, DeBenedetti MK, Gillanders WE, Norton JA, Doherty GM. Duodenopancreatic resections in patients with multiple endocrine neoplasia type 1. Ann Surg. 2000;231:909-18.
https://doi.org/10.1097/00000658-200006000-00016
33. Norton JA, Alexander HR, Fraker DL, Venzon DJ, Gibril F, Jensen RT. Comparison of surgical results in patients with advanced and limited disease with multiple endocrine neoplasia type 1 and Zollinger-Ellison syndrome. Ann Surg. 2001;234:495-506.
https://doi.org/10.1097/00000658-200110000-00009
34. Zogakis TG, Gibril F, Libutti SK, Norton JA, White DE, Jensen RT, et al. Management and outcome of patients with sporadic gastrinoma arising in the duodenum. Ann Surg. 2003;238:42-8.
https://doi.org/10.1097/01.SLA.0000074963.87688.31
35. Norton JA, Alexander HR, Fraker DL, Venzon DJ, Gibril F, Jensen RT. Does the use of routine duodenotomy (DUODX) affect rate of cure, development of liver metastases, or survival in patients with Zollinger-Ellison syndrome? Ann Surg. 2004;239:617-26.
https://doi.org/10.1097/01.sla.0000124290.05524.5e
36. Assalia A, Gagner M. Laparoscopic pancreatic surgery for islet cell tumors of the pancreas. World J Surg. 2004;28:1239-47.
https://doi.org/10.1007/s00268-004-7617-8
37. Pierce RA, Spitler JA, Hawkins WG, Strasberg SM, Linehan DC, Halpin VJ, et al. Outcomes analysis of laparoscopicresection of pancreatic neoplasms. Surg Endosc. 2007;21: 579-86.
https://doi.org/10.1007/s00464-006-9022-x
38. Fernández-Cruz L, César-Borges G. Laparoscopic strategies for resection of insulinomas. J Gastrointest Surg. 2006;10:752-60.
https://doi.org/10.1016/j.gassur.2005.08.012
39. Norton JA. Surgery for primary pancreatic neuroendocrine tumors. J Gastrointest Surg. 2006;10:327-31.
https://doi.org/10.1016/j.gassur.2005.08.023
40. Norton JA, Fraker DL, Alexander HR, Gibril F, Liewehr DJ, Venzon DJ, et al. Surgery increases survival in patients with gastrinoma. Ann Surg. 2006;244:410-9.
https://doi.org/10.1097/01.sla.0000234802.44320.a5
41. Imamura M, Komoto I, Ota S. Changing treatment strategy for gastrinoma in patients with Zollinger-Ellison syndrome. World J Surg. 2006;30:1-11.
https://doi.org/10.1007/s00268-005-0341-1
42. Morrow EH, Norton JA. Surgical management of ZollingerEllison syndrome: State of the art. Surg Clin North Am. 2009;89:1091-103.
https://doi.org/10.1016/j.suc.2009.06.018
43. Imamura M. Recent standardization of treatment strategy for pancreatic neuroendocrine tumors. World J Gastroenterol. 2010;16:4519-25.
https://doi.org/10.3748/wjg.v16.i36.4519
44. Imamura M, Komoto I, Ota S, Hiratsuka T, Kosugi S, Doi R, et al. Biochemically curative surgery for gastrinoma in multiple endocrine neoplasia type 1 patients. World J Gastroenterol. 2011;17:1343-53.
https://doi.org/10.3748/wjg.v17.i10.1343
45. Fendrich V, Bartsch DK. Surgical treatment of gastrointestinal neuroendocrine tumors. Langenbecks Arch Surg. 2011;396:299-311.
https://doi.org/10.1007/s00423-011-0741-7
46. Norton JA, Harris EJ, Chen Y, Visser BC, Poultsides GA, Kunz PC, et al. Pancreatic endocrine tumors with major vascular abutment, involvement, or encasement and indication for resection. Arch Surg. 2011;146:724-32.
https://doi.org/10.1001/archsurg.2011.129
47. Norton JA, Jensen RT. Resolved and unresolved controversies in the surgical management of patients with Zollinger-Ellison syndrome. Ann Surg. 2004;240:757-73.
https://doi.org/10.1097/01.sla.0000143252.02142.3e
48. Vargas CC, Castaño R. Tumores neuroendocrinos gastroenteropancreáticos. Rev Colomb Gastroenterol. 2010;25:165-76.
49. Epelboym I, Mazeh H. Zollinger-Ellison syndrome: Classical considerations and current controversies. Oncologist. 2014;19:44-50.
https://doi.org/10.1634/theoncologist.2013-0369
50. Zhang IY, Zhao J, Fernández-del-Castillo C, Braun Y, Razmdjou S, Warshaw AL, et al. Operative versus nonoperative management of nonfunctioning pancreatic neuroendocrine tumors. J Gastrointest Surg. 2016;20:277-83.
https://doi.org/10.1007/s11605-015-3043-5
51. Norton JA, Alexander RH, Fraker DL, Venzon DJ, Gibril F, Jensen RT. Comparison of surgical results in patients with advanced and limited disease with multiple endocrine neoplasia type 1 and Zollinger-Ellison syndrome. Ann Surg. 2001;234: 495-506.
https://doi.org/10.1097/00000658-200110000-00009
https://doi.org/10.1097/00000658-195510000-00015
2. Kent RB, van Heerden JA, Weiland LH. Nonfunctioning islet cell tumors. Ann Surg. 1981;193:185-90.
https://doi.org/10.1097/00000658-198102000-00010
3. Stabile BE, Morrow DJ, Passaro E. The gastrinoma triangle: Operative implications. Am J Surg. 1984;147:25-31.
https://doi.org/10.1016/0002-9610(84)90029-1
4. Norton JA, Alexander HR, Fraker DL, Venzon DJ, Gibril F, Jensen RT. Possibly primary lymph node gastrinoma: Occurrence, natural history, and predictive factors. Ann Surg. 2003;237:650-9.
https://doi.org/10.1097/01.SLA.0000064375.51939.48
5. Klöppel G, Clemens A. The biological relevance of gastric neuroendocrine tumors. Yale J Biol Med. 1996;69:69-74.
6. Hirschowitz BI. Pathobiology and management of hypergastrinemia and the Zollinger-Ellison syndrome. Yale J Biol Med. 1992;65:659-76.
7. Metz DC, Jensen RT. Gastrointestinal neuroendocrine tumors: Pancreatic endocrine tumors. Gastroenterology. 2008;135:1469-92.
https://doi.org/10.1053/j.gastro.2008.05.047
8. Osefo N, Ito T, Jensen RT. Gastric acid hypersecretory states: Recent insights and advances. Curr Gastroenterol Rep. 2009;11:433-41.
https://doi.org/10.1007/s11894-009-0067-6
9. Jensen RT, Berna MJ, Bingham DB, Norton JA. Inherited pancreatic endocrine tumor syndromes: Advances in molecular pathogenesis, diagnosis, management, and controversies. Cancer. 2008;113(Suppl.):1807-43.
https://doi.org/10.1002/cncr.23648
10. Bordi C, D'Adda T, Azzoni C, Ferraro G. Pathogenesis of ECL tumors in humans. Yale J Biol Med. 1998;71:273-84.
11. Waldum HL, Brenna E, Sandvik AK. Relationship of ECL cells and gastric neoplasia. Yale J Biol Med. 1998;71:325-35.
12. Burkitt MD, Varro A, Pritchard DM. Importance of gastrin in the pathogenesis and treatment of gastric tumors. World J Gastroenterol. 2009;15:1-16.
https://doi.org/10.3748/wjg.15.1
13. Doherty GM, Olson JA, Frisella MM, Lairmore TC, Wells SA, Norton JA. Lethality of multiple endocrine neoplasia type 1. World J Surg. 1998; 22:581-7.
https://doi.org/10.1007/s002689900438
14. Veldhuis JD, Norton JA, Wells SA, Vinik AI, Perry RR. Surgical versus medical management of multiple endocrine neoplasia (MEN) type 1. J Clin Endocrinol Metab. 1997;82:357-64.
https://doi.org/10.1210/jcem.82.2.3711-1
15. Lopez CL, Waldmann J, Fendrich V, Langer P, Kann PH, Bartsch DK. Long-term results of surgery for pancreatic neuroendocrine neoplasms in patients with MEN-1. Langenbecks Arch Surg. 2011;396:1187-96.
https://doi.org/10.1007/s00423-011-0828-1
16. Jkerström G, Stjlberg P, Hellman P. Surgical management of pancreatic-duodenal tumors in multiple endocrine neoplasia syndrome type 1. Clinics. 2012;67:173-8.
https://doi.org/10.6061/clinics/2012(Sup01)29
17. Wolfe MM, Jensen RT. Zollinger-Ellison syndrome - Current concepts in diagnosis and management. N Engl J Med. 1987;317:1200-9.
https://doi.org/10.1056/NEJM198711053171907
18. Feldman M, Schiller LR, Walsh JH, Fordtran JS, Richardson CT. Positive intravenous secretin test in patients with achlorhydria-related hypergastrinemia. Gastroenterology. 1987;93: 59-62.
https://doi.org/10.1016/0016-5085(87)90314-3
19. Andersen DK. Current diagnosis and management of ZollingerEllison syndrome. Ann Surg. 1989;210:685-703.
https://doi.org/10.1097/00000658-198912000-00001
20. Ito T, Cadiot G, Jensen RT. Diagnosis of Zollinger-Ellison syndrome: Increasingly difficult. World J Gastroenterol. 2012;18:5495-503.
https://doi.org/10.3748/wjg.v18.i39.5495
21. Rehfeld JF, Gingras MH, Bardram L, Hilsted L, Goetze JP, Poitras P. The Zollinger-Ellison syndrome and mismeasurements of gastrin. Gastroenterology. 2011;140:1444-53.
https://doi.org/10.1053/j.gastro.2011.01.051
22. Poitras P, Gingras MH, Rehfeld JF. The Zollinger-Ellison syndrome: Dangers and consequences of interrupting antisecretory treatment. Clin Gastroenterol Hepatol. 2012;10:199-202.
https://doi.org/10.1016/j.cgh.2011.08.012
23. Alexander HR, Fraker DL, Norton JA, Barlett DL, Tio L, Benjamin SB, et al. Prospective study of somatostatin receptor scintigraphy and its effect on operative outcome in patients with Zollinger-Ellison syndrome. Ann Surg. 1998;228:228-38.
https://doi.org/10.1097/00000658-199808000-00013
24. Gibril F, Reynolds JC, Lubensky IA, Roy PK, Peghini PL, Doppman JL, et al. Ability of somatostatin receptor scintigraphy to identify patients with gastric carcinoids: A prospective study. J Nucl Med. 2000;41:1646-56.
25. Levy AD, Sobin LH. Gastrointestinal carcinoids: Imaging features with clinicopathologic comparison. Radio Graphics. 2007;27:237-57.
https://doi.org/10.1148/rg.271065169
26. Sugg SL, Norton JA, Fraker DL, Metz DC, Pisegna JR, Fishbeyn V, et al. A prospective study of intraoperative methods to diagnose and resect duodenal gastrinomas. Ann Surg. 1993;218:138-44.
https://doi.org/10.1097/00000658-199308000-00004
27. Thompson NW, Vinik AI, Eckhauser FE. Microgastrinomas of the duodenum: A cause of failed operations for the ZollingerEllison syndrome. Ann Surg. 1989;209:396-404.
https://doi.org/10.1097/00000658-198904000-00002
28. McCarthy DM. The place of surgery in the Zollinger-Ellison syndrome. N Engl J Med. 1980;302:1344-47.
https://doi.org/10.1056/NEJM198006123022404
29. Harmon JW, Norton JA, Collin MJ, Krudy AG, Shawker TH, Doppman JL, et al. Removal of gastrinomas for control of Zollinger-Ellison syndrome. Ann Surg. 1984;200:396-403.
https://doi.org/10.1097/00000658-198410000-00002
30. Thomson AB, Sauve MD, Kassam N, Kamitakahara H. Safety of the long-term use of proton pump inhibitors. World J Gastroenterol. 2010;16:2323-30.
https://doi.org/10.3748/wjg.v16.i19.2323
31. Norton JA, Fraker DL, Alexander R, Venzon DJ, Doppman JL, Serrano J, et al. Surgery to cure the Zollinger-Ellison syndrome. N Engl J Med. 1999;341:635-44.
https://doi.org/10.1056/NEJM199908263410902
32. Laimore TC, Chen VY, DeBenedetti MK, Gillanders WE, Norton JA, Doherty GM. Duodenopancreatic resections in patients with multiple endocrine neoplasia type 1. Ann Surg. 2000;231:909-18.
https://doi.org/10.1097/00000658-200006000-00016
33. Norton JA, Alexander HR, Fraker DL, Venzon DJ, Gibril F, Jensen RT. Comparison of surgical results in patients with advanced and limited disease with multiple endocrine neoplasia type 1 and Zollinger-Ellison syndrome. Ann Surg. 2001;234:495-506.
https://doi.org/10.1097/00000658-200110000-00009
34. Zogakis TG, Gibril F, Libutti SK, Norton JA, White DE, Jensen RT, et al. Management and outcome of patients with sporadic gastrinoma arising in the duodenum. Ann Surg. 2003;238:42-8.
https://doi.org/10.1097/01.SLA.0000074963.87688.31
35. Norton JA, Alexander HR, Fraker DL, Venzon DJ, Gibril F, Jensen RT. Does the use of routine duodenotomy (DUODX) affect rate of cure, development of liver metastases, or survival in patients with Zollinger-Ellison syndrome? Ann Surg. 2004;239:617-26.
https://doi.org/10.1097/01.sla.0000124290.05524.5e
36. Assalia A, Gagner M. Laparoscopic pancreatic surgery for islet cell tumors of the pancreas. World J Surg. 2004;28:1239-47.
https://doi.org/10.1007/s00268-004-7617-8
37. Pierce RA, Spitler JA, Hawkins WG, Strasberg SM, Linehan DC, Halpin VJ, et al. Outcomes analysis of laparoscopicresection of pancreatic neoplasms. Surg Endosc. 2007;21: 579-86.
https://doi.org/10.1007/s00464-006-9022-x
38. Fernández-Cruz L, César-Borges G. Laparoscopic strategies for resection of insulinomas. J Gastrointest Surg. 2006;10:752-60.
https://doi.org/10.1016/j.gassur.2005.08.012
39. Norton JA. Surgery for primary pancreatic neuroendocrine tumors. J Gastrointest Surg. 2006;10:327-31.
https://doi.org/10.1016/j.gassur.2005.08.023
40. Norton JA, Fraker DL, Alexander HR, Gibril F, Liewehr DJ, Venzon DJ, et al. Surgery increases survival in patients with gastrinoma. Ann Surg. 2006;244:410-9.
https://doi.org/10.1097/01.sla.0000234802.44320.a5
41. Imamura M, Komoto I, Ota S. Changing treatment strategy for gastrinoma in patients with Zollinger-Ellison syndrome. World J Surg. 2006;30:1-11.
https://doi.org/10.1007/s00268-005-0341-1
42. Morrow EH, Norton JA. Surgical management of ZollingerEllison syndrome: State of the art. Surg Clin North Am. 2009;89:1091-103.
https://doi.org/10.1016/j.suc.2009.06.018
43. Imamura M. Recent standardization of treatment strategy for pancreatic neuroendocrine tumors. World J Gastroenterol. 2010;16:4519-25.
https://doi.org/10.3748/wjg.v16.i36.4519
44. Imamura M, Komoto I, Ota S, Hiratsuka T, Kosugi S, Doi R, et al. Biochemically curative surgery for gastrinoma in multiple endocrine neoplasia type 1 patients. World J Gastroenterol. 2011;17:1343-53.
https://doi.org/10.3748/wjg.v17.i10.1343
45. Fendrich V, Bartsch DK. Surgical treatment of gastrointestinal neuroendocrine tumors. Langenbecks Arch Surg. 2011;396:299-311.
https://doi.org/10.1007/s00423-011-0741-7
46. Norton JA, Harris EJ, Chen Y, Visser BC, Poultsides GA, Kunz PC, et al. Pancreatic endocrine tumors with major vascular abutment, involvement, or encasement and indication for resection. Arch Surg. 2011;146:724-32.
https://doi.org/10.1001/archsurg.2011.129
47. Norton JA, Jensen RT. Resolved and unresolved controversies in the surgical management of patients with Zollinger-Ellison syndrome. Ann Surg. 2004;240:757-73.
https://doi.org/10.1097/01.sla.0000143252.02142.3e
48. Vargas CC, Castaño R. Tumores neuroendocrinos gastroenteropancreáticos. Rev Colomb Gastroenterol. 2010;25:165-76.
49. Epelboym I, Mazeh H. Zollinger-Ellison syndrome: Classical considerations and current controversies. Oncologist. 2014;19:44-50.
https://doi.org/10.1634/theoncologist.2013-0369
50. Zhang IY, Zhao J, Fernández-del-Castillo C, Braun Y, Razmdjou S, Warshaw AL, et al. Operative versus nonoperative management of nonfunctioning pancreatic neuroendocrine tumors. J Gastrointest Surg. 2016;20:277-83.
https://doi.org/10.1007/s11605-015-3043-5
51. Norton JA, Alexander RH, Fraker DL, Venzon DJ, Gibril F, Jensen RT. Comparison of surgical results in patients with advanced and limited disease with multiple endocrine neoplasia type 1 and Zollinger-Ellison syndrome. Ann Surg. 2001;234: 495-506.
https://doi.org/10.1097/00000658-200110000-00009
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2016-07-01
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Beltrán, M. A. Síndrome De Zollinger-Ellison: Revisión Del Conocimiento Actual. Rev Colomb Cir 2016, 31, 197-211.
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