Is Endoscopic Resection Essential for Patients with Type 1 Gastric Neuroendocrine Tumor?

The gastric neuroendocrine tumor (g-NET) is now more frequently diagnosed due to the widespread use and advancement of endoscopy. In our study, we aimed to discuss the superiority, if any, between the watch-and-wait approach and endoscopic treatment methods for the controversial management of type 1 g-NETs, as well as to evaluate their long-term outcomes. The data of 81 patients who underwent gastroscopy due to complaints related to the upper gastrointestinal system and were diagnosed with type 1 g-NET as a result of biopsy taken from suspicious stomach lesions were examined. After exclusion criteria, 48 patients were included in the study. Patients were categorized into two groups: the watch-and-wait group, where no invasive procedure was performed, and the group that underwent any form of endoscopic resection. Thirty-seven patients were followed up regularly without any treatment. Eleven patients were followed up after endoscopic resection (endoscopic submucosal dissection-endoscopic mucosal resection). Endoscopic resection was performed in 5 of 37 patients with tumor size <10 mm and in 6 of 11 patients with tumor size between 10 and 20 mm. The median follow-up duration for all patients was 5 years, during which no instances of metastasis, tumor progression, or mortality were observed in any patient, regardless of whether they underwent endoscopic resection or not. This outcome prompts a questioning of the necessity for invasive treatment methods such as endoscopic resection, which comes with a relatively high cost and the potential for complications, in this particular patient group.