Jin T, Zhou YW, Sun PS, Huang Y, Gao JG, Jin X. Unraveling the characteristics of early esophageal neuroendocrine carcinoma using multi-model endoscopy: A retrospective study of serial cases. World J Gastrointest Oncol 2025; 17(11): 110715 [DOI: 10.4251/wjgo.v17.i11.110715]
Corresponding Author of This Article
Xi Jin, MD, PhD, Chief Physician, Professor, Department of Gastroenterology, The First Affiliated Hospital of Zhejiang University School of Medicine, No. 79 Qingchun Road, Shangcheng District, Hangzhou 310003, Zhejiang Province, China. jxfl007@zju.edu.cn
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Gastroenterology & Hepatology
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Retrospective Study
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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/
Nov 15, 2025 (publication date) through Nov 13, 2025
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World Journal of Gastrointestinal Oncology
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1948-5204
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Jin T, Zhou YW, Sun PS, Huang Y, Gao JG, Jin X. Unraveling the characteristics of early esophageal neuroendocrine carcinoma using multi-model endoscopy: A retrospective study of serial cases. World J Gastrointest Oncol 2025; 17(11): 110715 [DOI: 10.4251/wjgo.v17.i11.110715]
World J Gastrointest Oncol. Nov 15, 2025; 17(11): 110715 Published online Nov 15, 2025. doi: 10.4251/wjgo.v17.i11.110715
Unraveling the characteristics of early esophageal neuroendocrine carcinoma using multi-model endoscopy: A retrospective study of serial cases
Tian Jin, Yu-Wei Zhou, Pei-Sen Sun, Yue Huang, Jian-Guo Gao, Xi Jin
Tian Jin, Yu-Wei Zhou, Yue Huang, Jian-Guo Gao, Xi Jin, Department of Gastroenterology, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Pei-Sen Sun, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Co-first authors: Tian Jin and Yu-Wei Zhou.
Author contributions: Jin T drafted the manuscript; Jin T, Zhou YW, Sun PS, and Jin X contributed to data acquisition, analysis, and interpretation; Jin T and Jin X conceived and designed the study; Huang Y, Gao JG, and Jin X assisted with the writing of the study and literature review; Jin X conceived the overall concept of the article and supervised the research and writing processes. Jin T and Zhou YW contributed equally to this manuscript and are co-first authors. All the authors critically reviewed and approved the final manuscript and collectively decided to submit it for publication.
Supported by National Natural Science Foundation of China, No. 82370570.
Institutional review board statement: The study was approved by the Ethics Committee of The First Affiliated Hospital of Zhejiang University School of Medicine.
Informed consent statement: All study participants provided informed verbal consent prior to study inclusion.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Dataset available from the corresponding author.
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: Xi Jin, MD, PhD, Chief Physician, Professor, Department of Gastroenterology, The First Affiliated Hospital of Zhejiang University School of Medicine, No. 79 Qingchun Road, Shangcheng District, Hangzhou 310003, Zhejiang Province, China. jxfl007@zju.edu.cn
Received: June 16, 2025 Revised: August 6, 2025 Accepted: October 9, 2025 Published online: November 15, 2025 Processing time: 154 Days and 12.5 Hours
Abstract
BACKGROUND
Early esophageal neuroendocrine carcinoma (E-NEC) is a rare but aggressive malignancy with poorly understood endoscopic features. Despite advancements in multi-model endoscopy, including white light endoscopy, magnifying endoscopy narrow-band imaging (NBI), and endoscopic ultrasonography (EUS), the diagnostic characteristics of early E-NEC remain unclear. Comprehensive evaluation using these techniques can improve early detection and guide clinical management. This study aimed to investigate the endoscopic features of early E-NEC using multiple imaging modalities. We hypothesized that specific endoscopic patterns, such as irregular microvascular morphology or signs of submucosal invasion, could reliably distinguish early E-NEC from other esophageal lesions.
AIM
To characterize early E-NEC using multi-model endoscopy and identify diagnostic endoscopic features.
METHODS
Clinical data of four patients with esophageal submucosal lesions identified by gastroscopy and pathologically diagnosed as E-NEC in the Department of Gastroenterology, The First Affiliated Hospital of Zhejiang University School of Medicine between January 2020 and August 2024 were retrospectively analyzed, and their manifestations under multi-model endoscopy were observed. Grayscale values of ultrasound images in three patients with E-NEC and eight with esophageal leiomyoma were calculated using Image J software and compared using the Mann-Whitney U test.
RESULTS
Among the four patients with early E-NEC, two were males and two were females, with ages ranging from 60-70 years. White light endoscopy revealed three patients with mild local ulceration on the lesion surface. NBI images were available in two patients, revealing the intraepithelial papillary capillary loop of B1-B2 and B2 types. EUS was performed in three patients, all showing solitary hypoechoic lesions originating from the muscularis mucosa/mucosal muscular layer or submucosa; peripherally enlarged lymph node was observed in one patient. Average grayscale value of EUS images for early E-NEC (n = 3, 63.79 ± 1.42) was significantly higher than that for esophageal leiomyoma (n = 8, 49.44 ± 11.57; P = 0.01).
CONCLUSION
Endoscopic features of early E-NEC differ from those of esophageal leiomyoma, including NBI imaging, lymph node metastasis, and a notably higher echo intensity on EUS.
Core Tip: This was a retrospective observational study that investigated the endoscopic characteristics of early esophageal neuroendocrine carcinoma (E-NEC) and how they differed from those of other esophageal submucosal tumors. This study analyzed four patients with early E-NEC using multi-model endoscopy and revealed key diagnostic differences from esophageal leiomyomas, including higher echogenicity on endoscopic ultrasonography, irregular microvascular patterns on narrow-band imaging, and lymph node enlargement. These findings highlight the potential of combined endoscopic modalities to improve the early detection and diagnostic accuracy of E-NEC.
