Due to their increasing incidence, neuroendocrine neoplasms (NENs) are being detected more frequently by endoscopists while they are performing diagnostic upper or lower gastrointestinal (GI) endoscopies. These procedures are usually performed for unrelated indications or for screening, with the tumours often being detected incidentally. The most common scenario is of an endoscopist being surprised by receiving a histology report of a well-differentiated neuroendocrine tumour (NET) after biopsying a small polyp that was initially thought to be benign. This article aims to provide some guidance about what to do next in that situation. All patients with NET should, however, be referred to a fully constituted NEN multidisciplinary team for definitive investigations and management. In general, the site, size and number of any possible NENs should be fully assessed during the initial endoscopy and representative endoscopic images should be captured. If the initial endoscopic assessment was inadequate, the procedure may need to be repeated. Possible NENs should be sampled using biopsy forceps. Endoscopic resection should only be attempted following histological confirmation of the diagnosis and tumour grade and after additional investigations have been performed to fully stage the tumour and determine its hormone production status. This is essential so that patients do not undergo either unnecessary or inadequate endoscopic resections. This article discusses the endoscopic features and subsequent assessment of NENs that arise in the stomach, duodenum, terminal ileum and rectum, as these are the common tumour sites within the GI tract.

中文翻译：

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内窥镜检查发现的神经内分泌肿瘤：诊断和分期


由于神经内分泌肿瘤（NEN）的发病率不断增加，内窥镜医师在进行诊断性上消化道或下消化道（GI）内窥镜检查时更频繁地发现神经内分泌肿瘤（NEN）。这些手术通常是为了不相关的适应症或筛查而进行的，肿瘤经常被偶然发现。最常见的情况是，内窥镜医生在对最初被认为是良性的小息肉进行活检后，收到一份分化良好的神经内分泌肿瘤 (NET) 的组织学报告，感到惊讶。本文旨在提供一些有关在这种情况下下一步该怎么做的指导。然而，所有 NET 患者均应转诊至完整的 NEN 多学科团队进行明确的调查和管理。一般来说，在初次内窥镜检查期间应充分评估任何可能的 NEN 的部位、大小和数量，并应捕获有代表性的内窥镜图像。如果最初的内窥镜评估不充分，则可能需要重复该过程。应使用活检钳对可能的 NEN 进行取样。只有在组织学确认诊断和肿瘤分级并进行额外检查以对肿瘤进行全面分期并确定其激素产生状态后，才应尝试内镜切除术。这是至关重要的，这样患者就不会接受不必要或不充分的内镜切除术。本文讨论了胃、十二指肠、回肠末端和直肠中出现的 NEN 的内镜特征和后续评估，因为这些是胃肠道内常见的肿瘤部位。