Table 4.
Therapy of gastric neuroendocrine neoplasias (types 1–4)
| NET G1 without risk factors (for metastatic disease) | Risk factorsa | ||
|---|---|---|---|
| Size | ≤1 cm | 1–2 cm | mostly >2 cm |
| Type 1 | EMRb | EMR/ESD | surgery |
| Type 2 | EMRb | EMR/ESD | surgery |
| Type 3 | EMR/ESD or surgery | surgery | surgery |
| Type 4 | surgery |
a
Risk factors for metastatic disease are angioinvasion, G2–G3 histological grading, infiltration of the muscularis propria, enlarged regional lymph nodes, or tumor size ≥2 cm.
b
EMR may be considered for gastric NET G2 ≤ 1 cm, when Ki-67 is ≤5%.
Patients managed by EMR/ESD should be surveilled every 12 months. Type 4 gastric NEN are never benign; they are neuroendocrine carcinomas (NEC).
EMR = Endoscopic mucosal resection; ESD = endoscopic submucosal dissection; NET = neuroendocrine tumors.