Incidental encounters – unveiling neuroendocrine neoplasms in routine upper gastrointestinal endoscopy: A case series

• The incidence and prevalence of GEP-NENs is on a rise. • Nine cases of GEP-NENs were detected incidentally in patients having various GI complaints. • All polypoidal or submucosal lesions of the GI tract may be biopsied. Neuroendocrine neoplasms (NENs) of the gastrointestinal (GI) tract or pancreas are collectively called Gastroenteropancreatic NENs (GEP-NENs). The incidence and prevalence of these tumors is on a rise, owing to higher awareness and advanced diagnostic modalities. Many of them are incidentally detected during endoscopy or cross-sectional imaging. Here we present nine cases of GEP-NENs which were detected incidentally during their hospital visit for various GI complaints. Upper GI endoscopic biopsy was performed in 1052 patients at this single institution. Routine histopathology, and when needed, immunohistochemistry (IHC) tests were carried out. Final diagnosis of NEN was made on the basis of the 2019 WHO classification. Nine cases were histologically confirmed having NEN. The lesions were located in the duodenum in six cases and in the stomach in three. All except one were Grade 1 neuroendocrine tumors (NET), one patient had grade 2 NET. In three cases the NET was limited to mucosa and submucosal invasion was seen in six cases. Patients were managed with polypectomy( n = 2), endoscopic mucosal resection (EMR)( n = 2), endoscopic submucosal dissection (ESD)( n = 3), surgical resection( n = 1) and no therapeutic intervention, only regular follow up ( n = 1) All polypoidal or submucosal lesions of the GI tract may be biopsied to avoid missing out GEP-NENs. New and advanced techniques of GI endoscopy play a pivotal role in diagnosis and management of GEP-NENs. Here we are sharing our experience of upper GI tract NENs at a single gastroenterology super speciality centre in Eastern India.