Review article: the investigation and management of gastric neuroendocrine tumours. Issue 10 (13th March 2014)

• Record Type: Journal Article
• Authors: Basuroy, R.; Srirajaskanthan, R.; Prachalias, A.; Quaglia, A.; Ramage, J. K.
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 39:Issue 10(2014)
• Page Start: 1071
• Page End: 1084
• Publication Date: 2014-03-13
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.12698
• Languages: English
• ISSNs: 0269-2813

Abstract

<abstract abstract-type="main" id="apt12698-abs-0001"> <title>Summary</title> <sec id="apt12698-sec-0001" sec-type="section"> <title>Background</title> <p>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.</p> </sec> <sec id="apt12698-sec-0002" sec-type="section"> <title>Aim</title> <p>To review the literature and assist clinicians in managing patients with GCs.</p> </sec> <sec id="apt12698-sec-0003" sec-type="section"> <title>Methods</title> <p>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.</p> </sec> <sec id="apt12698-sec-0004" sec-type="section"> <title>Results</title> <p>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.</p> </sec> <sec id="apt12698-sec-0005" sec-type="section"> <title>Conclusions</title> <p>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.</p> </sec> </abstract>