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Somatostatin analogs for gastric carcinoids:for many, but not all

World Journal of Gastroenterology 2015年第22期21卷 6785-6793页

作者： Sara Massironi Alessandra Zilli Dario Conte Gastroenterology and Endoscopy Unit Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Department of Pathophysiology and Transplantation Università degli Studi di Milano

Gastric carcinoids(GCs) are classified as: type Ⅰ,related to hypergastrinemia due to chronic atrophic gastritis(CAG), type Ⅱ, associated with Zollinger-Ellison syndrome in multiple endocrine neoplasia type 1, and type Ⅲ, which is normogastrinemic. The management of type-Ⅰ gastric carcinoids(GC1s) is still debated,because of their relatively benign course. According to the European Neuroendocrine Tumor Society guidelines endoscopic resection is indicated whenever possible;however, it is not often feasible because of the presence of a multifocal disease, large lesions, submucosal invasion or, rarely, lymph node involvement. Therefore,somatostatin analogs(SSAs) have been proposed as treatment for GC1 s in view of their antisecretive,antiproliferative and antiangiogenic effects. However,in view of the high cost of this therapy, its possible side effects and the relatively benign course of the disease,SSAs should be reserved to specific subsets of "high risk patients", i.e., those patients with multifocal or recurrent GCs. Indeed, it is reasonable that, after the development of a gastric neuroendocrine neoplasm in patients with a chronic predisposing condition(such as CAG), other enterochromaffin-like cells can undergo neoplastic proliferation, being chronically stimulated by hypergastrinemia. Therefore, definite indications to SSAs treatment should be established in order to avoid the undertreatment or overtreatment of GCs.

关键词： Neuroendocrine tumors Atrophic gastritis Octreotide Lanreotide enterochromaffin-like cells Carcinoid tumors

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