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home - Stomach - Gastric Polyps and Masses - Carcinoid Endoscopy Written by Dr Sebastian Zeki

Carcinoid Endoscopy

Clinical FeaturesGastric carcinoids may present with peptic ulcer disease, abdominal pain or bleeding, and occasionally with atypical carcinoid syndrome.Duodenal carcinoids may produce duodenal or biliary obstruction or duodenal ulcer.Bronchial carcinoid can have a variant carcinoid syndrome with flushes that are severe and prolonged, lasting hours to days.Flushes are associated with disorientation, anxiety, and tremor. + + Related to mutations in Regl alpha gene, which may normally function as an autocrine or paracrine suppressor of gastrin stimulation of ECL proliferation. Associated with chronic atrophic gastritis and pernicious anaemia (65 % in one series). Type 1 70 to 80 % of all gastric carcinoids.Average age of onset is in the 60’s.This is more common in females.It is usually benign.These tumours do not give rise to the carcinoid syndrome. Type 3 Sporadic carcinoids as no disease associa-tions.20 % of gastric carcinoids.They are the most aggressive.Local or hepatic metastases are present in up to 65 % of patients who come to resection.Associated with carcinoid syndrome.Produce 5-HT; type 1 and 2 tumours produce serotonin. Endoscopy: Tumours usually <1cm, multiple, and can be polypoid with small central ulceration Type 2 Indolent.Associated with gastrinomas or (MEN) type 1.5 % of gastric carcinoids.Behave similarly to type 1. Local Disease High gastrin levels Normal gastrin levels Radical gastric resection + en bloc LN removal <2cm >2cm Endoscopic/ surgical resection Observe/Endoscopic resection/Octreotide for Zollinger-Ellison Metastasises To The Liver Metastases occur in < 10 % of tumours >2 cm, but >20 % of larger tumours. Convert into Type 1 gastric carcinoids Chronic gastritis Gastrin ECL Cells Stomach carcinoid Written by Dr Sebastian Zeki

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