Published online Sep 14, 2022. doi: 10.3748/wjg.v28.i34.4943
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
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.
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.