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Small bowel neuroendocrine tumors

Key sources
The following summarized guidelines for the evaluation and management of small bowel neuroendocrine tumors are prepared by our editorial team based on guidelines from the North American Neuroendocrine Tumor Society (NANETS 2017).
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Guidelines

1.Diagnostic investigations

Diagnostic imaging: obtain CT or MRI for the diagnosis, staging, and follow-up of patients with SBNETs.
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2.Diagnostic procedures

Small bowel endoscopy: consider performing video capsule endoscopy and double balloon enteroscopy in patients with unknown primary lesions, if the preoperative diagnosis is essential for referral for surgical management.
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3.Medical management

Systemic therapy: offer systemic therapy as first-line therapy in patients with poorly differentiated, high-grade SBNETs.
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  • Management of carcinoid crisis

4.Surgical interventions

Surgical exploration: perform surgical exploration in patients with metastatic gastroenteropancreatic NETs/carcinomas and undiagnosed primaries, as most of them will have SBNETs after imaging.
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  • Resection of primary tumor (indications)

  • Resection of primary tumor (technical considerations)

  • Lymph node dissection

  • Resection of metastases (peritoneal)

  • Resection of metastases (hepatic)

  • Prophylactic cholecystectomy

  • Liver transplantation

5.Specific circumstances

Patients with liver metastases and unknown primaries: obtain thin-slice multiphase CT of the abdomen, pelvis, and chest to evaluate the bronchi, thymus, stomach, duodenum, colorectum, appendix, pancreas, and small bowel with its mesentery for the staging of patients with NET liver metastases and unknown primaries.
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