Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2015; 21(22): 6785-6793
Published online Jun 14, 2015. doi: 10.3748/wjg.v21.i22.6785
Somatostatin analogs for gastric carcinoids: For many, but not all
Sara Massironi, Alessandra Zilli, Dario Conte
Sara Massironi, Alessandra Zilli, Dario Conte, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, I-20122 Milan, Italy
Alessandra Zilli, Dario Conte, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, I-20122 Milan, Italy
Author contributions: Massironi S designed the paper and wrote the first draft of the manuscript; Zilli A contributed to data acquisition and carried out the literature research; Conte D critically revised the manuscript for relevant intellectual content about neuroendocrine tumors; Massironi S and Zilli A wrote the final version of the manuscript; all the authors finally approved this manuscript.
Conflict-of-interest: No conflicting interests (including commercial, personal, political, intellectual, or religious interests) to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sara Massironi, MD, PhD, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy. sara.massironi@policlinico.mi.it
Telephone: +39-2-55033445 Fax: +39-2-55033644
Received: January 20, 2015
Peer-review started: January 21, 2015
First decision: February 10, 2015
Revised: February 22, 2015
Accepted: April 16, 2015
Article in press: April 17, 2015
Published online: June 14, 2015
Abstract

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 GC1s 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.

Keywords: Neuroendocrine tumors, Atrophic gastritis, Octreotide, Lanreotide, Enterochromaffin-like cells, Carcinoid tumors

Core tip: The management of type-I gastric carcinoids is still debated because of their relatively benign course against the fact that they can have a heterogeneous unpredictable biological behavior. Even if in most cases their endoscopic treatment is effective, in some particular cases it may not be sufficient. The potential role of somatostatin analogs (SSAs) has been reported in several recent studies. However, neither a standard indication nor a specific schedule of treatment with defined dosage and duration have been adopted to date. Because of the high cost of SSAs, clear-cut indications for this therapy are required in order to avoid any overtreatment.