Zollinger-Ellison syndrome: past, present and future controversies.

It is fitting that the Zollinger-Ellison syndrome (ZES) be included in the Lester Dragstedt Symposium because Dr. Dragstedt had a long-time interest in this disease, having been one of the five discussants of the original article and subsequently reporting with Dr. Oberhelman on nine cases. The approach to therapy of ZES has been controversial from the beginning, and a number of controversies remain. In this article, four different controversies are analyzed from the prospective of the past (Zollinger-Dragstedt era, 1955-1980), present and what may happen in the future in light of recent results. Specifically analyzed are: 1) the role of gastric surgery in the management; 2) whether gastrinoma removal without aggressive resection in patients with ZES without MEN-I is the preferred surgical therapy; 3) whether patients with MEN-I should undergo routine surgical exploration; and 4) whether most gastrinomas will be localized preoperatively. An analysis of recent advances suggests there may be marked changes in the future from our current and our past approaches.