Preoperative US or CT scanning is helpful in patients with endocrine pancreatic tumors to show large primaries and metastases if malignancy is present. No other procedures are necessary and indicated for patients who have not had previous operations. ES can be used preoperatively in gastrinomas or insulinomas if a laparoscopic approach is planned. At laparotomy, IOUS is useful for patients with gastrinoma and insulinoma. Because about 70% of gastrinomas are located in the duodenum, a DUODX is necessary to identify these often small tumors. For patients with persistent or recurrent gastrinoma or insulinoma, a similar approach is used, including ES and the Imamura procedure.

The results of localization procedures in patients with MEN 1 gastrinomas or insulinomas have been frustrating because these patients usually have multiple small tumors throughout the gland. On the other hand, both tumor syndromes are treated by standardized resections, leading to limited value of these techniques.


We thank Prof. Kann, Department of Internal Medicine and Endocrinology, for giving us the endosonography figures.


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