Therapeutic Challenges for Gastric Neuroendocrine Neoplasms: Take It or Leave It?

A single center retrospective analysis of feasibility of diagnostic endoscopic resection for grade 1 or 2 gastric neuroendocrine tumors

Currently, endoscopic resection is recommended for gastric neuroendocrine tumors (G-NETs) < 10 mm. However, a larger G-NETs can also be resected endoscopically. Here, we evaluated the feasibility of diagnostic endoscopic resection of G-NETs. We retrospectively analyzed 31 patients, diagnosed with grade 1 or 2 G-NETs at a single tertiary referral center, between January 2009 and December 2023. Outcomes analyzed included histopathology, complete resection, and metastasis rates. The mean follow-up period was 38.9 ± 38.4 months; mean size of G-NETs was 4.9 ± 3.4 mm, and the most size of G-NETs were < 10 mm (87.1%). The maximal NET diameter was 16 mm. Most NETs were grade 1 (type 1: 90.9%; type 3: 85.0%). None of the enrolled patients showed evidence of lymph node metastasis or local recurrence. Even in R1 resection (19.4%) showed no metastasis during follow-up without additional surgery. Recurrent or multiple G-NETs were observed only in patients with type 1 NETs (27.2%, 3/11). Modified endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) showed a 100% complete resection rate. After resection, grade 1 or 2 G-NETs had no lymph nodes or distant metastases during the follow-up period. This study suggests that G-NETs smaller than 16 mm can be considered for diagnostic endoscopic resection and this resection may be potentially definitive treatment.

Neuroendocrine Neoplasia: From Pathophysiology to Novel Therapeutic Approaches

Neuroendocrine neoplasia (NEN) represents a sensational field of modern medicine; immense progress in emerging biochemical, molecular, endocrine, immunohistochemical, and serum tumour markers of disease, respectively, which are part of early diagnosis, genetic testing, and multidisciplinary approaches [...].

Endoscopic management of gastric, duodenal and rectal NETs: Position paper from the Italian Association for Neuroendocrine Tumors (Itanet), Italian Society of Gastroenterology (SIGE), Italian Society of Digestive Endoscopy (SIED)

The present paper reflects the position of the Italian Association for Neuroendocrine Tumors (Itanet), the Italian Society of Gastroenterology (SIGE), and the Italian Society of Digestive Endoscopy (SIED) regarding the management of patients affected by gastric, duodenal, and rectal neuroendocrine neoplasms (NENs) amenable to endoscopic treatment. The key questions discussed in this paper are summarized in Table 1. Data were extracted from the MEDLINE database through searches; expert opinions and recommendations are provided in accordance with the available scientific evidence and the authors' expertise. Recommendations are presented alongside a level of evidence and grade of recommendation based on the GRADE system. This paper specifically focuses on subgroups of NENs considered suitable for endoscopic management according to current international guidelines: i. well-differentiated gastric neuroendocrine tumors (gNET) type 1 < 2 cm and selected cases of type 3; ii. well-differentiated duodenal, non-functioning, non-ampullary NET with size < 2 cm; and well-differentiated rectal NET with size < 2 cm.