What is the surgical treatment of choice for symptomatic Zollinger-Ellison syndrome?

The surgical treatment of choice for symptomatic Zollinger-Ellison syndrome is surgical resection of gastrinoma. Zollinger-Ellison syndrome is characterized by gastrin-secreting tumors, known as gastrinomas, which lead to increased gastric acid production and various gastrointestinal symptoms such as recurrent peptic ulcers and diarrhea.

Surgical resection is particularly indicated for gastrinomas that are localized and resectable, as this can significantly reduce gastrin levels and alleviate symptoms. The goal of the surgery is to remove the gastrinoma and any involved lymphatic tissue thoroughly. If the tumor is located in the pancreas or the duodenum, an attempt is made to excise it completely.

While medical therapy, such as proton pump inhibitors, can manage the symptoms and help control acid secretion, it does not address the underlying gastrinoma itself. Options like endoscopic ablation are typically not effective for gastrinomas, which are usually deeper and require a more extensive surgical approach. Gastrectomy is not a standard treatment for Zollinger-Ellison syndrome as it does not specifically target the gastrinoma and can lead to other complications.

In summary, the focus on removing the gastrin-secreting tumor through surgical resection is essential in managing symptomatic Zoll