Clinical Endoscopy

Systematic Review and Meta-Analysis

A systematic review on endoscopic ultrasound in gastric neuroendocrine neoplasms: guidelines outpacing evidence: Matteo Marasco, Gianluca Esposito, Marianna Signoretti, Maria Rinzivillo, Francesco Panzuto; Received December 15, 2024 Accepted March 5, 2025 Published online April 24, 2025; DOI: https://doi.org/10.5946/ce.2024.343 [Epub ahead of print]

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Gastric neuroendocrine neoplasms (g-NENs), though rare, have shown a rise in incidence due to increased endoscopic screening and improved diagnostic awareness. International guidelines recommend the use of endoscopic ultrasound (EUS) in managing g-NENs to evaluate subepithelial lesion size, depth, and lymph node involvement before endoscopic resection. However, the supporting evidence for EUS’s role in g-NENs is scarce and limited.
Methods
According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a comprehensive literature search was conducted on PubMed to identify studies about the role of EUS in g-NENs, including both retrospective and prospective human studies.
Results
A total of 355 studies were considered; however, only seven were included, highlighting EUS’s diagnostic utility in g-NENs, with only 44 specific cases. EUS showed promise in assessing tumor characteristics critical for endoscopic resection. Nevertheless, its diagnostic accuracy remained variable across lesion types, and its impact on clinical decision-making in g-NENs lacked robust evidence. EUS contributed to subepithelial lesion staging but was underrepresented in neuroendocrine tumor-specific studies, creating a knowledge gap.
Conclusions
This review underscores the need for larger multicenter studies to validate EUS’s efficacy and reliability in g-NEN management. Prospective trials are crucial to strengthen guidelines and provide clearer clinical guidance for managing these tumors.

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Original Article

The role of needle-based confocal laser endomicroscopy in the diagnosis of pancreatic neuroendocrine tumors: Masanori Yamada, Kazuo Hara, Nobumasa Mizuno, Shin Haba, Takamichi Kuwahara, Nozomi Okuno, Yasuhiro Kuraishi, Takafumi Yanaidani, Sho Ishikawa, Tsukasa Yasuda, Toshitaka Fukui; Clin Endosc 2024;57(3):393-401. Published online September 12, 2023; DOI: https://doi.org/10.5946/ce.2023.068

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a highly accurate method for diagnosing pancreatic neuroendocrine tumors (PNETs); however, some PNETs are difficult to diagnose. Recently, the efficacy of needle-based confocal laser endomicroscopy (nCLE) in diagnosing solid pancreatic masses has been reported. However, the efficacy of nCLE in the diagnosis of PNETs remains unknown and only a small number of cases have been reported. Hence, this study aimed to evaluate the efficacy of nCLE in the diagnosis of PNETs.
Methods
This single-center retrospective study evaluated 30 consecutive patients with suspected PNETs on contrast-enhanced computed tomography, who consented to nCLE combined with EUS-FNA and were diagnosed using EUS-FNA or surgical resection. The diagnostic criteria for PNETs using nCLE were based on the nesting and trabecular and glandular arrangement of tumor cell clusters surrounded by capillary vessels and fibrosis, as reported in previous studies.
Results
The diagnosis using nCLE was classified into three categories: misdiagnosis in three cases (10%), non-diagnostic in six cases (20%), and diagnostic in 21 cases (70%). nCLE was able to diagnose PNET in one of the two cases with inconclusive EUS-FNA.
Conclusions
Although further development of the resolution and optimization of the diagnostic criteria are required, nCLE may constitute a useful diagnostic option in cases of inconclusive EUS-FNA for PNETs.

Citations

Citations to this article as recorded by

Recent developments in the diagnosis of pancreatic neuroendocrine neoplasms
Anna Battistella, Matteo Tacelli, Paola Mapelli, Marco Schiavo Lena, Valentina Andreasi, Luana Genova, Francesca Muffatti, Francesco De Cobelli, Stefano Partelli, Massimo Falconi
Expert Review of Gastroenterology & Hepatology.2024; 18(4-5): 155. CrossRef
Advancements and challenges in gastrointestinal imaging
Eun Jeong Gong, Chang Seok Bang
World Journal of Clinical Cases.2024; 12(33): 6591. CrossRef

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Reviews

Endoscopic treatment for rectal neuroendocrine tumor: which method is better?: Seung Min Hong, Dong Hoon Baek; Clin Endosc 2022;55(4):496-506. Published online July 11, 2022; DOI: https://doi.org/10.5946/ce.2022.115

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