Editorial
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 21, 2017; 23(27): 4847-4855
Published online Jul 21, 2017. doi: 10.3748/wjg.v23.i27.4847
Evolving role of the endoscopist in management of gastrointestinal neuroendocrine tumors
Cemal Yazici, Brian R Boulay
Cemal Yazici, Brian R Boulay, Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois Hospital and Health Sciences System, Chicago, IL 60612, United States
Author contributions: Yazici C and Boulay BR both contributed to literature search, initial draft and critical revision of this article prior to submission.
Conflict-of-interest statement: Yazici C and Boulay BR declare no conflict of interest related to this publication.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Brian R Boulay, MD, MPH, Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois Hospital and Health Sciences System, 840 South Wood Street, MC 716, Chicago, IL 60612, United States. bboulay@uic.edu
Telephone: +1-312-4131999 Fax: +1-312-4133798
Received: January 29, 2017
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
Abstract

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.

Keywords: Carcinoid; Gastrointestinal; Endoscopy; Endoscopic submucosal dissection; Neuroendocrine tumor

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.