Published online Jul 21, 2017. doi: 10.3748/wjg.v23.i27.4847
Peer-review started: February 10, 2017
First decision: April 7, 2017
Revised: May 5, 2017
Accepted: June 9, 2017
Article in press: June 12, 2017
Published online: July 21, 2017
Processing time: 172 Days and 9.3 Hours
Neuroendocrine tumors (NETs) are uncommon gastrointestinal neoplasms but have been increasingly recognized over the past few decades. Luminal NETs originate from the submucosa of the gastrointestinal tract and careful endoscopic exam is a key for accurate diagnosis. Despite their reputation as indolent tumors with a good prognosis, some NETs may have aggressive features with associated poor long-term survival. Management of NETs requires full understanding of tumor size, depth of invasion, local lymphadenopathy status, and location within the gastrointestinal tract. Staging with endoscopic ultrasound or cross-sectional imaging is important for determining whether endoscopic treatment is feasible. In general, small superficial NETs can be managed by endoscopic mucosal resection and endoscopic submucosal dissection (ESD). In contrast, NETs larger than 2 cm are almost universally treated with surgical resection with lymphadenectomy. For those tumors between 11-20 mm in size, careful evaluation can identify which NETs may be managed with endoscopic resection. The increasing adoption of ESD may improve the results of endoscopic resection for luminal NETs. However, enthusiasm for endoscopic resection must be tempered with respect for the more definitive curative results afforded by surgical treatment with more advanced lesions.
Core tip: Neuroendocrine tumors (NETs) are uncommon but increasingly recognized gastrointestinal neoplasms. Management of NETs requires full understanding of tumor size, depth of invasion, lymphadenopathy, and location within the gastrointestinal tract. Small NETs can be removed by endoscopic techniques, while NETs > 2 centimeters typically require surgery. For tumors 11-20 mm in size, careful evaluation can identify which NETs may be managed with endoscopic resection. Endoscopic submucosal dissection has been increasingly used for treatment of luminal NETs. However, enthusiasm for endoscopic resection must be tempered with respect for the more definitive curative results afforded by surgical treatment with more advanced lesions.