The Fellowship of the European Board of Surgery in Hepatopancreatobiliary Surgery (FEBS-HPB) tests the full spectrum of liver, pancreatic and biliary disease. Practise with board-style FEBS-HPB questions covering resectability assessment, HPB oncology, benign disease and operative decision-making, each answer referenced to ESMO, IHPBA and landmark HPB trials.
Content reviewed 26 August 2026 against current guidelines.
Start practising freeTaken from the bank, not written for this page. Answer it in your head, then open the explanation.
A 42-year-old man presents with recurrent peptic ulcers refractory to PPI therapy. Fasting gastrin is 1,200 pg/mL (normal <100). A secretin stimulation test shows a paradoxical rise in gastrin of >200 pg/mL above baseline. CT shows a 2-cm hypervascular lesion in the gastrinoma triangle. Where is the gastrinoma triangle located?
Correct answer: B
✓ Correct answer: The gastrinoma triangle, described by Stabile et al. in 1984, is the anatomical region where approximately 90% of sporadic gastrinomas are found. It is defined by three landmarks forming a triangle: (1) the junction of the cystic duct and common bile duct superiorly, (2) the junction of the second and third portions of the duodenum inferiorly, and (3) the junction of the neck and body of the pancreas medially. Most gastrinomas are found within this triangle, with the most common locations being the duodenal wall (especially the first and second portions, accounting for 50-70% of cases) and the pancreatic head (20-40%). Duodenal gastrinomas are often small (<1 cm), submucosal, and difficult to identify on preoperative imaging or even intraoperatively without duodenotomy and transillumination. The clinical scenario presents classic Zollinger-Ellison syndrome: recurrent refractory peptic ulcers, markedly elevated fasting gastrin (>10x normal), and a positive secretin stimulation test (paradoxical rise >120-200 pg/mL, depending on the threshold used). The secretin test distinguishes ZES from other causes of hypergastrinemia such as PPI use, atrophic gastritis, or G-cell hyperplasia, where gastrin decreases or shows only a minimal rise after secretin. ✗ Why the others are wrong: A: Calot's triangle (cystic duct, common hepatic duct, liver edge) is relevant to cholecystectomy anatomy, not gastrinoma localization. C: This region does not correspond to any named anatomical triangle for gastrinoma localization. The left renal vein, splenic artery, and IMV are relevant to left-sided pancreatic and retroperitoneal surgery. D: The portal triad (hepatic artery, portal vein, common bile duct) is an important hepatobiliary landmark but is not the gastrinoma triangle. E: The area between the SMA, celiac axis, and aorta is the aortocaval region relevant to retroperitoneal lymphadenectomy, not gastrinoma localization. Teaching point: Gastrinoma triangle: CBD-cystic duct junction, D2-D3 junction, pancreatic neck-body junction. 90% of gastrinomas are found here. Most common site is the duodenal wall. Board pearl: Secretin stimulation test: paradoxical gastrin rise >200 pg/mL = ZES. Gastrin decreases with secretin in other causes of hypergastrinemia. 60-90% of sporadic gastrinomas are in the duodenum. Pitfall: Missing small duodenal gastrinomas. They are often <1 cm and submucosal. Intraoperative duodenotomy with palpation and transillumination is essential for localization.
Teaching point. Gastrinoma triangle: CBD-cystic duct junction, D2-D3 junction, pancreatic neck-body junction. 90% of gastrinomas are found here. Most common site is the duodenal wall.
Referenced to ENETS Consensus Guidelines 2016
Every question is explained like this — start with 50 free ›Every question is written by Pablo Lozano Lominchar, MD, PhD, and mapped to this board’s published syllabus. Before it enters the bank it has to pass an automated check: five options, a written explanation, and a citation — a named society guideline or a named trial. Benign and functional topics cannot be published without a society guideline; oncological ones cite NCCN, ESMO or AJCC, and the classification systems that govern a topic — Bethesda, TIRADS, Atlanta, Prague, Chicago — have to appear where they apply. The author has audited the full active bank against current guideline versions: what fails is re-cited, rewritten or withdrawn. 650 questions are currently withdrawn and are served to nobody.
Concentrate on resectability criteria, staging and multidisciplinary management of hepatocellular carcinoma, colorectal liver metastases, pancreatic and biliary cancers. Practise timed HPB questions and confirm each answer against the ESMO/IHPBA guideline it cites to build oral-exam-ready reasoning.
SurgBoardsQ&A provides more than 3,000 hepatopancreatobiliary practice questions mapped to the FEBS-HPB syllabus, each with a detailed, guideline-referenced explanation.
FEBS-HPB covers liver tumours (HCC, cholangiocarcinoma, colorectal liver metastases), pancreatic cancer and cystic neoplasms, biliary tract disease, portal hypertension, and the principles of hepatic and pancreatic resection.
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