We review our institution's experience with gastrointestinal (GI) carcinoid tumors over the past three decades: fifty-five cases with complete follow-up. The majority of carcinoids were from the ileum and appendix--19 cases (35%) and 17 cases (31%), respectively. Other locations included the cecum in five (9%), duodenum in three (5%), jejunum in three (5%), rectum in three (5%), and pylorus in one (2%). Four patients had metastatic carcinoid of uncertain primary (7%). Appendiceal carcinoids were frequently incidental and small (all < 1 cm). None were metastatic, and all appeared to have been cured with simple appendectomy. In contrast, ileal carcinoids were usually symptomatic and often metastatic at the time of diagnosis. Carcinoid syndrome occurred in 10 patients (18%), associated primarily with metastatic tumors from the ileum and cecum. Secondary malignancies were seen in 10 patients (18%). We provide a literature survey of GI carcinoid tumors and carcinoid syndrome.