The American Journal of Gastroenterology · 2 authors, 2 centres
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This narrative review summarizes epidemiology, diagnosis, staging, and endoscopic/surgical management of gastrointestinal neuroendocrine tumors for gastroenterologists. It emphasizes accurate staging and grading as critical to prognosis and highlights that resection method depends on tumor size, location, and grade.
This narrative review addresses the increasing incidence of gastrointestinal neuroendocrine tumors (NETs) and provides guidance for gastroenterologists on diagnosis, staging, and management. The authors describe endoscopic characteristics of NETs, noting that low-grade and high-grade tumors cannot be differentiated endoscopically. Chromogranin A is identified as having limited sensitivity and specificity as a marker. The World Health Organization grading system using mitotic index and Ki-67 index is presented as correlating with prognosis. Gallium-68 Dotatate PET scans are reported to have sensitivity of 91% and specificity of 94% for initial NET diagnosis. Management recommendations vary by location: gastric NET subtypes I and II with favorable survival may be managed endoscopically if smaller than 2 cm, while type III gastric NETs carry 5-year survival below 50%. Duodenal NETs smaller than 1 cm have low (2%) nodal involvement risk, while jejunal and ileal NETs require surgical resection regardless of size due to metastatic potential. Subcentimeter rectal NETs without adverse features have 98.9%–100% 5-year survival.
