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World J Gastroenterol. Sep 14, 2022; 28(34): 4943-4958
Published online Sep 14, 2022. doi: 10.3748/wjg.v28.i34.4943
Diagnosis, treatment, and current concepts in the endoscopic management of gastroenteropancreatic neuroendocrine neoplasms
Giuseppe Iabichino, Milena Di Leo, Monica Arena, Giovanni Giuseppe Rubis Passoni, Elisabetta Morandi, Francesca Turpini, Paolo Viaggi, Carmelo Luigiano, Luca De Luca
Giuseppe Iabichino, Milena Di Leo, Monica Arena, Giovanni Giuseppe Rubis Passoni, Elisabetta Morandi, Francesca Turpini, Paolo Viaggi, Luca De Luca, Digestive Endoscopy Unit, ASST Santi Paolo e Carlo, Milano 20144, Italy
Carmelo Luigiano, Gastroenterology Section, Grande Ospedale Metropolitano “Bianchi-Melacrino-Morelli”, Reggio Calabria 89124, Italy
Author contributions: All authors made substantial contributions to the conception of the study and literature search, drafted the manuscript or revised it critically for important intellectual content, and approved the final version of the manuscript to be published.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
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: Luca De Luca, MD, Director, Doctor, Digestive Endoscopy Unit, ASST Santi Paolo e Carlo, Via Antonio di Rudinì 8, Milano 20144, Italy. lucadeluca1210@gmail.com
Received: April 11, 2022
Peer-review started: April 11, 2022
First decision: May 12, 2022
Revised: June 29, 2022
Accepted: August 22, 2022
Article in press: August 22, 2022
Published online: September 14, 2022
Processing time: 148 Days and 18.2 Hours
Abstract

Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) are rare tumors derived from the neuroendocrine cell system, which that have increased in incidence and prevalence in recent years. Despite improvements in radiological and metabolic imaging, endoscopy still plays a pivotal role in the number of GEP-NENs. Tumor detection, characterization, and staging are essential in management and treatment planning. Upper and lower gastrointestinal (GI) endoscopy is essential for correct localization of the primary tumor site of GI NENs. Endoscopic ultrasonography (EUS) has an important role in the imaging and tissue acquisition of pancreatic NENs and locoregional staging of GI neuroendocrine tumors. Correct staging and histological diagnosis have important prognostic implications. Endoscopic operating techniques allow the removal of small GI NENs in the early stage of mucosal or submucosal invasion of the intestinal wall. Preoperative EUS-guided techniques may help the surgeon locate small and deep tumors, thus avoiding formal pancreatic resections in favor of parenchymal-sparing surgery. Finally, locoregional ablative treatments have been proposed in recent studies with promising results in selected patients.

Keywords: Neuroendocrine neoplasms; Gastrointestinal endoscopy; Endoscopic resection; Endoscopic ultrasound; Ablative technique; Tissue acquisition

Core Tip: Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) are complex neoplasms that present many clinical challenges. This review reports endoscopic management of patients with GEP-NENs. Endoscopic procedures allow diagnosis, local staging, and tissue acquisition. Early NENs of the stomach, duodenum, or rectum are generally removed by endoscopic operating techniques. New endoscopic ultrasonography-guided operative techniques may help the surgeon locate small and deep tumors or treat small pancreatic NENs.