Abstract
Background. Intra-arterial calcium stimulation with hepatic venous sampling (ASVS) for insulin
gradients has been reported to be the most sensitive preoperative localizing technique
for insulinomas. We reviewed our experience with ASVS to localize and guide the treatment
of insulinomas over the past decade. Methods. Eighteen patients who underwent ASVS before surgical exploration for insulinoma were
studied. The accuracy of ASVS was compared with intraoperative findings and other
localizing studies. Results. There were no complications arising from the procedures. A more than 2-fold step-up
in insulin level 30 to 60 seconds after injection to at least 1 feeding artery was
observed in 16 patients. Fourteen of the 16 solitary tumors (87.5%) were correctly
located; 100% (6/6 tumors) at the head and 80% (8/10 tumors) at the body/tail. The
overall accuracy of this test was 89%, compared with 11%, 33%, 38%, and 63% of ultrasonography,
computed tomography, magnetic resonance imaging, and endoscopic ultrasonography, respectively.
Six enucleations and 10 distal resections were performed, which included 2 laparoscopic
procedures. The combination of intraoperative ultrasonography with preoperative ASVS
identified all tumors. Conclusions. ASVS is the most accurate preoperative localization tool for the localization of
insulinomas and, in combination with intraoperative ultrasonography, can enhance surgical
success. (Surgery 2000;128:903-9.)
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Article info
Footnotes
*Reprint requests: Chung, Yau Lo, FRCS (Edin), FACS, Division of Endocrine Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam, Hong Kong, China.
**Surgery 2000;128:903-9.
Identification
Copyright
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
