Systematic Reviews
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2022; 28(26): 3258-3273
Published online Jul 14, 2022. doi: 10.3748/wjg.v28.i26.3258
Endoscopic techniques for diagnosis and treatment of gastro-entero-pancreatic neuroendocrine neoplasms: Where we are
Roberta Elisa Rossi, Alessandra Elvevi, Camilla Gallo, Andrea Palermo, Pietro Invernizzi, Sara Massironi
Roberta Elisa Rossi, HPB Surgery, Hepatology and Liver Transplantation, ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale Tumori (INT, National Cancer Institute), Milan 20133, Italy
Alessandra Elvevi, Camilla Gallo, Andrea Palermo, Pietro Invernizzi, Sara Massironi, Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza 20900, Italy
Author contributions: Rossi RE designed the research; Rossi RE, Elvevi A, Gallo C, Palermo A, and Massironi S performed the literature search and wrote the first draft of the paper; Rossi RE, Invernizzi P and Massironi S reviewed for important intellectual content; Rossi RE and Massironi S wrote the final version of the paper; all the authors approved it.
Conflict-of-interest statement: None.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Roberta Elisa Rossi, MD, PhD, Doctor, HPB Surgery, Hepatology and Liver Transplantation, ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale Tumori (INT, National Cancer Institute), Via G. Venezian 1, Milan 20133, Italy. robertaelisa.rossi@gmail.com
Received: October 27, 2021
Peer-review started: October 27, 2021
First decision: December 27, 2021
Revised: January 4, 2022
Accepted: April 15, 2022
Article in press: April 15, 2022
Published online: July 14, 2022
Processing time: 258 Days and 15.3 Hours
Abstract
BACKGROUND

The correct localization of the primary tumor site and a complete histological diagnosis represent the milestones for the proper management of gastro-entero-pancreatic neuroendocrine neoplasms (GEP-NENs).

AIM

To analyze current evidence on the role of endoscopy in the diagnosis/treatment of GEP-NENs.

METHODS

An extensive bibliographical search was performed in PubMed to identify guidelines and primary literature (retrospective and prospective studies, systematic reviews, case series) published in the last 15 years, using both medical subject heading (MeSH) terms and free-language keywords: gastro-entero-pancreatic neuroendocrine neoplasms; endoscopy; ultrasound endoscopy; capsule endoscopy; double-balloon enteroscopy; diagnosis; therapy; staging.

RESULTS

In the diagnostic setting, endoscopic ultrasonography (EUS) represents the diagnostic gold standard for pancreatic NENs and the technique of choice for the locoregional staging of gastric, duodenal and rectal NENs. The diagnosis of small bowel NENs (sbNENs) has been improved with the advent of video capsule endoscopy and double-balloon enteroscopy, which allow for direct visualization of the entire small bowel; however, data regarding the efficacy/safety of these techniques in the detection of sbNENs are scanty and often inconclusive. From a therapeutic point of view, endoscopic removal is the treatment of choice for the majority of gastric NENs (type 1/2), for well-differentiated localized nonmetastatic duodenal NENs < 1 cm, confined to the submucosa layer and for < 10 mm, stage T1–T2, rectal NENs. EUS-guided pancreatic locoregional ablative treatments have been proposed in recent studies with promising results in order to control symptoms or reduce tumor burden in selected patients.

CONCLUSION

Standard axial endoscopy and EUS still play a pivotal role in several GEP-NENs. Advanced techniques for increasing the rate of R0 resection should be reserved for high-volume referral centers.

Keywords: Gastro-entero-pancreatic neuroendocrine neoplasms; Endoscopy; Ultrasound endoscopy; Capsule endoscopy; Double-balloon enteroscopy; Diagnosis; Therapy; Staging

Core tip: Standard axial endoscopy and endoscopic ultrasonography (EUS) play a pivotal role in gastro-entero-pancreatic neuroendocrine neoplasms (GEP-NENs). Upper/lower gastrointestinal endoscopy is essential for the detection of gastrointestinal NENs. EUS represents the diagnostic gold standard for pancreatic NENs and the technique of choice for the locoregional staging of gastric, duodenal and rectal NENs. The diagnosis of small bowel NENs has been improved with the advent of capsule endoscopy and double-balloon enteroscopy, however, their use is limited in clinical practice. In selected localized GEP-NENs, endoscopic therapy is appropriate with radical intent. The multidisciplinary management and the referral to high-volume tertiary centers remain fundamental.