Neuroendocrine neoplasms (NENs), also called neuroendocrine tumors (NETs), are relatively uncommon, heterogenous tumors primarily originating in the gastrointestinal tract. With the improvement in technology and increasing use of cross-sectional imaging and endoscopy, they are being discovered with increasing frequency. Although traditionally considered indolent tumors with good prognoses, some NENs exhibit aggressive behavior. Timely diagnosis, risk stratification, and management can often be a challenge. In general, small NENs without local invasion or lymphovascular involvement can often be managed using minimally invasive advanced endoscopic techniques, while larger lesions and those with evidence of lymphovascular invasion require surgery, systemic therapy, or a combination thereof. Ideal management requires a comprehensive and accurate understanding of the stage and grade of the tumor. With the recent advancements, a therapeutic advanced endoscopist can play a pivotal role in diagnosing, staging, and managing this rare condition. High-definition white light imaging and digital image enhancing technologies like narrow band imaging (NBI) in the newer endoscopes have improved the diagnostic accuracy of traditional endoscopy. The refinement of endoscopic ultrasound (EUS) over the past decade has revolutionized the role of endoscopy in diagnosing and managing various pathologies, including NENs. In addition to EUS-directed diagnostic biopsies, it also offers the ability to precisely assess the depth of invasion and lymphovascular involvement and thus stage NENs accurately. EUS-directed locoregional ablative therapies are increasingly recognized as highly effective, minimally invasive treatment modalities for NENs, particularly pancreatic NENs. Advanced endoscopic resection techniques like endoscopic submucosal dissection (ESD), endoscopic submucosal resection (EMR), and endoscopic full-thickness resection (EFTR) have been increasingly used over the past decade with excellent results in achieving curative resection of various early-stage gastrointestinal luminal lesions including NENs. In this article, we aim to delineate NENs of the different segments of the gastrointestinal (GI) tract (esophagus, gastric, pancreatic, and small and large intestine) and their management with emphasis on the endoscopic management of these tumors.
神经内分泌肿瘤（NENs），亦称神经内分泌瘤（NETs），是一类相对少见且异质性较强的肿瘤，主要起源于胃肠道。随着技术进步以及横断面成像和内镜检查的广泛应用，其检出率日益增高。尽管传统上认为这类肿瘤进展缓慢且预后良好，但部分NENs仍表现出侵袭性行为。及时诊断、风险分层和治疗策略制定常面临挑战。一般而言，未发生局部浸润或淋巴血管侵犯的小型NENs可采用微创内镜技术进行治疗；而较大病灶及存在淋巴血管侵犯证据者则需要手术、全身治疗或联合治疗方案。理想的治疗决策需基于对肿瘤分期与分级的全面精准评估。随着近年技术发展，治疗型高级内镜医师在这一罕见疾病的诊断、分期和治疗中可发挥关键作用。新一代内镜配备的高清白光成像及窄带成像等数字图像增强技术，显著提升了传统内镜的诊断准确性。过去十年间，超声内镜技术的精进彻底革新了内镜在包括NENs在内的多种疾病诊疗中的作用。除超声内镜引导下的诊断性活检外，该技术还能精准评估肿瘤浸润深度及淋巴血管侵犯情况，从而实现NENs的准确分期。超声内镜引导下的局部消融治疗已被广泛认可为NENs（尤其是胰腺NENs）高效微创的治疗方式。近十年来，内镜黏膜下剥离术、内镜黏膜切除术及内镜全层切除术等高级内镜切除技术日益普及，在包括NENs在内的多种早期胃肠道腔内病变根治性切除中取得了卓越成效。本文旨在系统阐述胃肠道不同区段（食管、胃、胰腺及大小肠）NENs的诊疗策略，并重点探讨这些肿瘤的内镜治疗进展。
肿瘤(癌症)患者之家