Diagnosis, treatment, and current concepts in the endoscopic management of gastroenteropancreatic neuroendocrine neoplasms

Figure 1 Gastric neuroendocrine neoplasm. A: Endoscopic image demonstrates a flat lesion in the stomach fundus with depressed center; B: Endoscopic en bloc resection was achieved.

Figure 2 Duodenal neuroendocrine neoplasm. A: Endoscopic image demonstrates a sessile polyp with central depression; B: Endoscopic ultrasound demonstrates a hypoechoic intramural structure in the submucosal layer of the duodenal wall.

Figure 3 Pancreatic neuroendocrine neoplasm. A: Endoscopic ultrasound revealed a 15 mm hypoechoic lesion of the pancreas; B: Stained immunohistochemically for chromogranin showing diffuse and strong positivity (original magnification 400 ×), consistent with a poorly differentiated neuroendocrine tumor infiltrating the entire thickness of the muscle tissue to the head of the pancreas; C: The proliferation index (Ki-67) < 20%.

Figure 4 Algorithm for gastric neuroendocrine neoplasm management. EMR: Endoscopic mucosal resection; ESD: Endoscopic submucosal dissection; EUS: Endoscopic ultrasonography; G-NEN: Gastric neuroendocrine neoplasm.

Figure 5 Algorithm for duodenal neuroendocrine neoplasms management. D-NEN: Duodenal neuroendocrine neoplasm; ER: Endoscopic resection.

Figure 6 Algorithm for rectal neuroendocrine neoplasms management. ESD: Endoscopic submucosal dissection; mEMR: Modified endoscopic mucosal resection; R-NEN: Rectal neuroendocrine neoplasm; TEM: Transanal endoscopic microsurgery.