Review article: the investigation and management of gastric neuroendocrine tumours

R Basuroy, R Srirajaskanthan, A Prachalias, A Quaglia, J K Ramage

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    88 Citations (Scopus)

    Abstract

    BACKGROUND: Gastric carcinoids (GCs) or neuroendocrine tumours (NETs) are increasingly identified at endoscopy, and account for 0.6-2% of all gastric polyps identified. The SEER database in the US has demonstrated a rising incidence of gastric NETs amongst all NETs; from 2.2% between 1950 and 1969 to 6.0% between 2000 and 2007.

    AIM: To review the literature and assist clinicians in managing patients with GCs.

    METHODS: A literature search was conducted through MEDLINE using search terms: gastric, carcinoid, neuroendocrine tumour, therapy, endoscopy, mucosal resection, submucosal dissection. Relevant articles were identified through manual review. The reference lists of these articles were reviewed to include further appropriate articles.

    RESULTS: There are three types of GCs with important epidemiological, pathophysiological, histological and endoscopic differences that affect prognosis and management. Type 1 and 2 GCs develop in the context of hypergastrinaemia that originates from achlorhydria in atrophic gastritis and a gastrinoma, respectively. Type 3 GCs occur sporadically and independent of gastrin. The histological type, grade and Ki67 index are used to determine prognosis and direct clinical management. Type 1 GCs >1 cm in size and type 2 GCs should be assessed for invasion beyond the submucosa with EUS prior to endoscopic resection with EMR or ESD. Type 3 GCs should be managed as per recommendations for gastric adenocarcinoma. The treatment of advanced disease is multimodal.

    CONCLUSIONS: Patients with gastric carcinoids should be discussed in a specialist neuroendocrine tumour multidisciplinary meeting to ensure all treatment options are explored in localised and advanced disease. Areas of controversy exist that need further research.

    Original languageEnglish
    Pages (from-to)1071-84
    Number of pages14
    JournalAlimentary Pharmacology and Therapeutics
    Volume39
    Issue number10
    DOIs
    Publication statusPublished - May 2014

    Keywords

    • Dissection
    • Endoscopy
    • Gastrins
    • Gastritis, Atrophic
    • Humans
    • Neuroendocrine Tumors
    • Polyps
    • Prognosis
    • Stomach Neoplasms

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