Advanced Endoscopy Fellows Program | September 2022-Shaffer Mok_Endoscopic Approach to Neuroendocrine Tumors

Shaffer Mok_Endoscopic Approach to Neuroendocrine Tumors

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This document discusses the endoscopic approach to neuroendocrine tumors (NETs). Gastric NETs (g-NETs) account for 23% of cases and have different subtypes: type I (70-80%), type II (5-6%), and type III (15-20%). Each subtype has its own clinical presentations, such as dyspepsia or anemia in type I, abdominal pain and diarrhea in type II, and a clinical presentation similar to gastric adenocarcinoma in type III/IV. Diagnosing g-NETs involves histopathology confirmation, laboratory tests, and imaging. Duodenal NETs (d-NETs) comprise 2.8% of all NETs and have various types, including gastrinomas, somatostatinomas, and non-functional tumors. Clinical presentations include symptoms related to functioning tumors and the presence of single, small, pale, or reddish lesions in the duodenum. Multiple d-NETs or the presence of g-NETs may indicate MEN-1. The management of d-NETs involves surgical resection with adjuvant chemotherapy for grade G3 tumors and poorly differentiated NETs, while endoscopic resection may be done in selected cases. Prognosis depends on size, grade, and functionality, with non-functioning d-NETs having a better outcome. Rectal NETs (r-NETs) arise from L-cells and are classified based on size and grade. Imaging techniques, such as EUS, MRI, CT, and PET, are used to assess the extent of invasion and lymph node involvement. The management of r-NETs includes regular follow-ups for completely resected tumors and different treatment modalities based on size and invasiveness. Overall, endoscopic resection is a crucial part of NET management, and the endoscopist should be familiar with various techniques for better outcomes.

Keywords

neuroendocrine tumors

gastric NETs

duodenal NETs

clinical presentations

diagnosis

endoscopic resection

prognosis

rectal NETs

imaging techniques

endoscopist