Endocrine Abstracts

Background: People who have autoimmune atrophic gastritis commonly develop type 1 gNETs, but are also at increased risk of developing gastric adenocarcinoma. Type I gNET patients usually have multiple gastric polyps and have an excellent prognosis when the polyps measure.

Method: Retrospective audit of type I gNET patients managed within Liverpool ENETS Centre of Excellence 2004–2018.

Results: 86 patients (median age 67 years, 54 female) had histologically confirmed type I gNETs. Median polyp number was 8 (range 1–50) and median diameter of the largest polyp was 7 mm (range 1–50 mm). 48 patients had grade 1 and 15 grade 2 tumours (information not available on 23 as Ki67 immunohistochemistry was not routinely performed in the earlier years of the audit period). Initial management involved endoscopic resection in five cases and partial/total gastrectomy in nine. Three patients chose no follow up and one died from an unrelated cause soon after diagnosis. 68 patients entered an endoscopic surveillance programme (median follow up 43 months (range 1–162 months), median number of endoscopies 3 (range 1–10)). Two patients showed increases in polyp diameter to 14 mm (no intervention undertaken), two showed increased grade from 1 to 2 (no intervention undertaken as polyps measured 7 mm) and one patient developed an increase in gNET size and grade, but was unfit for intervention due to cirrhosis. One patient developed gastric adenocarcinoma requiring gastrectomy and one developed high grade gastric dysplasia (HGD) requiring endoscopic resection. 61 patients showed no significant change.

Conclusion: 5 of 68 patients developed changes in gNET size/grade, but no treatment was undertaken. Two patients developed gastric adenocarcinoma/HGD needing intervention. Although regular endoscopic surveillance detects changes in gNETS in a small proportion of patients, it is also important for the detection of gastric adenocarcinoma.