Letters To The Editor
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World J Gastroenterol. Sep 21, 2011; 17(35): 4052-4054
Published online Sep 21, 2011. doi: 10.3748/wjg.v17.i35.4052
Hypergastrinemia and recurrent type 1 gastric carcinoid in a young Indian male: Necessity for antrectomy?
Viplove Senadhi, Niraj Jani
Viplove Senadhi, Division of Gastroenterology and Hepatology, Indiana Institute for Personalized Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States
Niraj Jani, Johns Hopkins University/Sinai Hospital and the Greater Baltimore Medical Center, Chief of Division of Gastroenterology, Baltimore, MD 21204, United States
Author contributions: Senadhi V wrote, revised and gathered all the data for the manuscript; Senadhi V corresponded with the editors and incorporated the revisions; Jani N reviewed and modified the manuscript; Jani N was the mentor author on the manuscript; both authors reviewed and approved the final version of the manuscript.
Correspondence to: Dr. Senadhi V, Division of Gastroenterology and Hepatology, Indiana University, 1050 Wishard Blvd, Suite 4100, Indianapolis, IN 46202, United States. vsenadhi@hotmail.com
Telephone: + 1-317-9480414   Fax: +1-678-6235999
Received: November 15, 2010
Revised: May 21, 2011
Accepted: May 28, 2011
Published online: September 21, 2011

Carcinoid tumors are the most common neuroendocrine tumors. Gastric carcinoids represent 2% of all carcinoids and 1% of all gastric masses. Due to the widespread use of Esophagogastroduodenoscopy for evaluating a variety of upper gastrointestinal symptoms, the detection of early gastric carcinoids has increased. We highlight an alternative management of a young patient with recurrent type 1 gastric carcinoids with greater than 5 lesions, as well as lesions intermittently greater than 1 cm. Gastric carcinoids have a variable presentation and clinical course that is highly dependent on type. Type 1 gastric carcinoids are usually indolent and have a metastasis rate of less than 2%, even with tumors larger than 2 cm. There are a number of experts as well as organizations that recommend endoscopic resection for all type 1 gastric carcinoid lesions less than 1 cm, with a follow-up every 6-12 mo. They also recommend antrectomy for type 1 gastric carcinoids with greater than 5 lesions, lesions 1 cm or greater, or refractory anemia. However, the American Society of Gastrointestinal Endoscopy guidelines state that type 1 gastric carcinoid surveillance is controversial based on the evidence and could not make an evidence-based position statement on the best treatment modality. Our report illustrates a rare cause of iron deficiency anemia in a young male (without any medical history) due to multiple recurrent gastric carcinoid type 1 lesions in the setting of atrophic gastritis causing hypergastrinemia, and in the absence of a vitamin B12 deficiency. Gastric carcinoid type 1 can present in young males without an autoimmune history, despite the known predilection for women aged 50 to 70 years. Type 1 gastric carcinoids can be managed by endoscopic resection in patients with greater than 5 lesions, even with lesions larger than 1 cm. This course of treatment enabled the avoidance of early antrectomy in our patient, who expressed a preference against more invasive measures at his young age.

Keywords: Gastric carcinoid, Antrectomy, Endoscopic resection, Hypergastrinemia, Iron deficiency anemia