Asian Institute of Gastroenterology, Hyderabad, 500 082, India.
Indian J Gastroenterol. 2023 Apr;42(2):158-172. doi: 10.1007/s12664-023-01362-8. Epub 2023 May 2.
The incidence of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) has increased over the last several decades. In general, NETs are slow-growing neoplasms and the data on the natural history is still evolving. The availability and improved utilization of advanced imaging modalities have allowed the selection of cases suitable for endotherapy. In this regard, endoscopic ultrasound (EUS) has emerged as a central imaging modality to assess the depth of infiltration in gastroduodenal as well as rectal NETs. Enhanced EUS modalities, including contrast-enhanced EUS and EUS elastography, reliably differentiate pancreatic neuroendocrine tumors (PNETs) from adenocarcinomas and may enable prediction of aggressive PNETs. With recent developments in therapeutic endoscopy, a large proportion of GEP-NETs can be safely managed endoscopically. Endoscopic resection techniques, including endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), allow the safe removal of gastroduodenal and rectal NETs. Recent data indicate that modified EMR techniques may be superior to conventional EMR with regard to histologically complete resection. Device-assisted endoscopic full thickness resection is emerging as a safe and effective technique for upper gastrointestinal as well as rectal NETs. In selected cases with PNETs, who are otherwise unfit for surgery, EUS-guided ablation is increasingly being recognized as a safe treatment option. This review focusses on evidence-based approaches to endoscopic evaluation and the management of GEP-NETs with special emphasis on recent advancements.
过去几十年来，胃胰肠神经内分泌肿瘤（GEP-NETs）的发病率有所增加。一般来说，NETs 生长缓慢，其自然病史数据仍在不断发展。先进影像学检查方法的普及和应用改善使得选择适合内镜治疗的病例成为可能。在这方面，内镜超声（EUS）已成为评估胃十二指肠和直肠 NETs 浸润深度的主要影像学方法。增强型 EUS 检查方法，包括对比增强 EUS 和 EUS 弹性成像，能够可靠地区分胰腺神经内分泌肿瘤（PNETs）与腺癌，并可能有助于预测侵袭性 PNETs。随着治疗性内镜技术的最新发展，很大一部分 GEP-NETs 可以安全地进行内镜治疗。内镜切除技术，包括内镜黏膜切除术（EMR）和内镜黏膜下剥离术（ESD），可安全切除胃十二指肠和直肠 NETs。最近的数据表明，改良的 EMR 技术在组织学完全切除方面可能优于传统的 EMR。器械辅助内镜全层切除术是一种安全有效的治疗上消化道和直肠 NETs 的方法。在那些不适合手术的 PNETs 患者中，EUS 引导下消融术越来越被认为是一种安全的治疗选择。本文重点介绍基于证据的 GEP-NETs 内镜评估和管理方法，特别强调了最新进展。
