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Baillière’s Clinical Gastroenterology
  1. P N MATON

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Baillière’s Clinical Gastroenterology. Volume 10. Number 4. Gastrointestinal Endocrine Tumours. O’Shea D, Bloom SR. (Pp 211; illustrated: £30.00.) London: Baillière Tindall, 1996. ISBN 0-7020-2186-5.

This book consists of a series of chapters on each of the major gut endocrine tumour syndromes and four general chapters on the pathology, the peptide receptors possessed by these tumours, and medical and surgical treatment. The emphasis of the book is clinical, and all of the chapters are written by authors who have a large personal experience of these rare tumours.

A chapter on carcinoid tumours discusses the characteristics of the various different tumours that arise from the different sites in the gastrointestinal tract. The carcinoid syndrome is briefly discussed, as is prognosis. In this chapter there is virtually no discussion of treatment modalities. The chapter on gastrinoma details the diagnosis and clinical features and the unique problems of tumour localisation in this syndrome. In contrast to the previous chapter, one third of this chapter is devoted to treatment, including a discussion of the place of acid antisecretory therapy, surgery, chemotherapy, somatostatin analogues, hepatic embolisation, and even hepatic transplantation. A section on insulinoma is provided by the Mayo Clinic group. Unlike the other gut endocrine tumours, most insulinomas are benign. The implications of this for both medical and surgical therapy are fully analysed. The experience with VIP producing tumours, both of the gastrointestinal tract and of the neuroblastomas that occur in children, is described by the Ohio group, and the Hammersmith Hospital experience with the glucagonoma syndrome, is described by Drs Frankston and Bloom. Surprisingly, in a book like this, no account is given of the very rare gut endocrine tumours, including GHRH producing tumours, Cushing’s syndrome, hypercalcaemia producing tumours, somatostatinomas, or the non-functioning endocrine tumours. They are, however, mentioned briefly in the chapter on surgical treatment.

The chapter on pathology by Drs Bishop and Polak is the clearest account I have ever read of the significance and limitations of the various immunochemistry techniques used to identify these tumour types. The chapter on peptide receptors on gut endocrine tumours is almost exclusively about the clinical relevance of somatostatin receptors for tumour localisation and therapy with octreotide. The chapters on medical and surgical therapy are, in some instances, the only source of information about a syndrome, but in other cases the information is redundant and, on occasion, potentially confusing. For example, in the surgical chapter, less emphasis on gastrinoma and insulinoma would have been appropriate, and in the medical chapter, more information on treatment of carcinoids, and a more critical discussion of the limitations of chemotherapy studies would have been useful.

At whom is this book directed? The emphasis is clinical, so presumably it is directed at clinicians. These tumours are rare and most clinicians when they see such a patient, are likely to turn to what they hope is a definitive account of diagnosis, management and prognosis. Have there been major advances in this field in the past few years that justify a new monograph? Most of these gut endocrine syndromes were described by the 1970s, and the role of chemotherapy and hepatic embolisation has changed little in recent years. Octreotide did change medical therapy in the 1980s and tumour imaging in the 1990s, and surgical therapy has become more refined, particularly in gastrinoma. Does this monograph provide better information than is available in standard textbooks? In some cases that is certainly true, but in others it is questionable, and the chapters vary widely in the references provided.

If you do not possess a large standard textbook and need an account of gut endocrine tumours, this monograph is excellent in many ways, but may not provide you with all you want. For the rest of us, this is one to look at in the library.