Published online Jul 14, 2022. doi: 10.3748/wjg.v28.i26.3258
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
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).
To analyze current evidence on the role of endoscopy in the diagnosis/treatment of GEP-NENs.
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.
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.
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.
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.