Abstract:

Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) are the main type of neuroendocrine neoplasms (NENs). Their incidence rate has been increasing year by year, with variations in distribution across different regions and populations. The 2025 edition of the "Guidelines for Diagnosis and Treatment of Neuroendocrine Neoplasms" provides new guidance on endoscopic diagnosis and treatment of gastrointestinal NENs (GI-NENs). Based on comprehensive stratification criteria incorporating tumor size, pathological grading, and anatomical location, endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) are recommended exclusively for G₁ tumors with lesions ≤ 10 mm in diameter, confined to the mucosa / submucosa without muscularis layer invasion or metastasis. For G₂ neoplasms with lesions ≤ 15 mm and Ki-67 < 10%, endoscopic intervention should be cautiously considered only for patients who cannot tolerate surgery. Digestive endoscopy, with its dual capabilities of visualized targeted biopsy and minimally invasive intervention, plays an important role in the diagnosis and treatment of GI-NENs. Endoscopic therapy is not simply a technical procedure, but requires a comprehensive decision-making process based on tumor staging, grading, systemic function evaluation, and molecular characteristics. Only through multidisciplinary collaboration, the in-depth integration of endoscopic precision evaluation, imaging examination, and systemic therapy, the construction of a whole-process management system, and the accumulation of evidence-based medical data can the limitations of heterogeneity be overcome and the diagnosis and treatment of NENs be advanced toward precision and personalization.

Key words: Neuroendocrine neoplasms, Guidelines, Endoscopy, Diagnosis, Treatment