Endoscopic Ultrasonographic Features And Diagnosis And Treatment Of Gastroenteropancreatic Neuroendocrine Neoplasms

BackgroundNeuroendocrine neoplasms are heterogeneous tumor originating from the secretory cells of the diffuse neuroendocrine system.Neuroendocrine cells are a large group of cells with relatively slow growth rate and the ability to secrete various peptide hormones and biogenic amines.Neuroendocrine cells are scattered in various systems,so neuroendocrine neoplasms can be distributed in different anatomical locations of the body,but the most common are stomach,intestine,pancreas and other digestive system organs,more than half of all neuroendocrine neoplasms.Most neuroendocrine neoplasms are sporadic,and their exact etiology is still under study.Genetic factors may be related to their occurrence.The diagnosis of gastroenteropancreatic neuroendocrine neoplasms is a major challenge because these neoplasms have a variety of usually non-specific clinical manifestations,such as choking,abdominal pain,abdominal mass,hematochezia,intestinal obstruction and so on,most of these clinical symptoms are related to the location of the neoplasms.At present,more than half of gastroenteropancreatic neuroendocrine neoplasms are accidentally found during imaging diagnostic examinations or endoscopic examinations for other indications,while focal lesions of the primary and metastatic lesions may be small and usually located in atypical locations and are not easily detected.Therefore,the imaging diagnosis of neuroendocrine neoplasms is very important to determine the location of the primary focus,the classification of the disease,the selection of treatment methods and the monitoring of its effect.In recent years,with the improvement of people’s understanding and diagnosis and treatment of NENs,the research on its pathological features,choice of treatment,postoperative complications and prognosis has achieved great success.However,in view of its low incidence and wide variety,its diagnosis is still the first priority,and no single imaging method is sufficient.Therefore,in order to correctly diagnose and choose the best treatment method,multiple imaging diagnosis should be combined with its morphology and function for evaluation.With the continuous development of ultrasound endoscopy in recent years,clinicians’ awareness and operation level of ultrasound endoscopy have been continuously improved.Because of its intuitiveness and operability,the accurate diagnosis of endoscopic ultrasound for digestive tract lesions has been recognized.This enables endoscopic physicians to better evaluate the positioning,level,size,and margins of GEP-NENs in combination with ultrasound images,providing an important basis for further surgical treatment.Endoscopic minimally invasive treatment is also more important because of its advantages.It is more and more accepted by the general public and has become the current preferred treatment method.Ultrasound endoscopic assessment of the lesion before endoscopic treatment can more intuitively evaluate the condition of the lesion,avoid risks during surgery,and improve the complete resection rate of the lesion,provide better treatment results.ObjectiveTo explore the imaging manifestations of gastroenteropancreatic neuroendocrine neoplasms in different imaging diagnoses,analyze the advantages and disadvantages of different imaging diagnoses and the advantages of ultrasound endoscopy,summarize the treatment methods,and analyze the complete resection and clinical factors of lesions under ultrasound endoscopy.To evaluate the value of endoscopic ultrasonography in the treatment of gastrointestinal neuroendocrine neoplasms.Materials and MethodsA total of 199 patients with gastrointestinal and pancreatic neuroendocrine neoplasms treated in the first affiliated Hospital of Zhengzhou University from May 2017 to May 2019 were selected for study:(1)General data:statistics of patients’sex、age、location and distribution of lesions and their grading.(2)Retrospectively analyze its imaging diagnostic data,organize its imaging performance and characteristics,and analyze its advantages and disadvantages.Summarize the treatment methods and record the complete resection rate and complication rate of endoscopically treated patients.(3)SPSS 24.0 was used for statistical analysis.The counting data were analyzed by x2 test and the four-table exact probability method.The difference was statistically significant at P<0.05.ResultsAmong the 199 patients with gastroenteropancreatic neuroendocrine neoplasms,110 were males and 89 were females.The average age was 54.37 ±7.58 years old(range:22-67 years old),According to their pathological stage,they were classified as 80 cases in G1(40.2%),40 cases in G2(20.1%),and 79 cases in G3(39.7%).Endoscopic ultrasound is the first choice for imaging examination.CT and MRI can be used as the inspection plan for suspected cases of gastroenteropancreatic neuroendocrine neoplasms,which have certain diagnostic significance for smaller cases and distant metastatic cases.Endoscopic treatment,surgical treatment,drug therapy,radiotherapy and chemotherapy are the most common treatment options.Pancreatic neuroendocrine neoplasms are mostly treated with surgery,drugs or radiotherapy due to their anatomical location,and gastrointestinal neuroendocrine neoplasms are mostly treated with endoscope,A total of 115 cases were treated.A total of 68 cases were completely resected by pathological examination,most of which were neoplasms with a mass of less than 10 mm and G1 gastrointestinal neuroendocrine neoplasms located in the mucosal layer(P<0.05,statistical significance),at the same time,the complications of intraoperative perforation and postoperative delayed bleeding were observed.There were 2 intraoperative perforations and 5 postoperative delayed bleeding.No surgical treatment was added after timely and effective management of complications.Conclusions1.Patients with neuroendocrine neoplasms are specific in different imaging examinations.Endoscopic ultrasonography has advantages over other imaging studies in the localization of gastroenterppancreatic neuroendocrine neoplasms.2.The grading is determined according to its imaging diagnosis,which is of guiding significance for the selection of treatment methods.3.Gastrointestinal neuroendocrine neoplasms are treated under the guidance of ultrasound endoscopy,which can improve the complete resection rate of endoscopic treatment,reduce the incidence of complications,and obtain better prognosis.