Gastric carcinoids. The Yale Experience
I. M. Modlin, C. J. Gilligan, G. P. Lawton, L. H. Tang, A. B. West and U. Darr
Department of Surgery, Yale University School of Medicine, West Haven, Conn.
OBJECTIVES: To document our experience with gastric carcinoids over the
past decade and to identify lesion frequency and the existence of a
relationship to low acid states. DESIGN: Retrospective case series.
SETTING: Tertiary care referral center. PATIENTS: A consecutive sample of
16 patients with gastric carcinoids was evaluated over the last decade.
Only two cases were recorded in the prior decade. Ages ranged from 30 to 93
years (mean, 65.9 years). There were eight men and eight women. Three
patients were unavailable for follow-up. INTERVENTIONS: Therapy included
total gastrectomy (n = 4), subtotal gastrectomy (n = 3), endoscopic
polypectomy (n = 3), and endoscopic surveillance (n = 6). MAIN OUTCOME
MEASURES: Pathobiological tumor characteristics and survival. RESULTS: All
carcinoids were of gastric fundic origin. None of the patients exhibited
the carcinoid syndrome. Chronic atrophic gastritis was the most frequently
observed comorbid pathologic condition (63%). Half of the patients had
multiple polypi. Mean follow-up was 4.7 years (n = 13). There were 10
survivors. The only related death occurred in a patient with a solitary
tumor. CONCLUSIONS: Diagnosis of the complex and ill-defined entity of
gastric carcinoid is increasing. This may be due to an increased awareness
and increased upper gastrointestinal endoscopy rate rather than an increase
in real incidence. Criteria for prediction of malignant progression are not
available. Multiple gastric carcinoids associated with hypergastrinemia
predominantly display nonaggressive behavior. Conservative gastric surgery
may be appropriate therapy for such patients.
