Continuing Medical Education Questions: April 2023

Abstract

Article Title: What Every Gastroenterologist Should Know About Gastrointestinal NETs

LEARNING OBJECTIVE

After this activity, the participant will be able to recognize and manage neuroendocrine tumors (NET) of the gastrointestinal tract effectively.

QUESTION 1

A 60-year-old man is referred for upper endoscopy by his primary care provider (PCP) due to persistent post-prandial abdominal pain and reflux symptoms. He had a computed tomography (CT) scan of his abdomen performed by his PCP prior to referral, which was noted to be unremarkable. During the upper endoscopy, you note smooth and pale mucosa in the corpus, along with multiple polypoid lesions measuring 3–7 mm in size, all with reddish appearance with a small central erosion. The remainder of the upper endoscopy is negative. Biopsies of the representative lesions return consistent for well-differentiated NET. You check a serum gastrin level which returns high.

You refer the patient for endoscopic ultrasound (EUS), which is negative for lymph nodes, and confirms hypoechoic appearance arising from the deep submucosal layer without invasion into the muscularis. What is your next step?

1. Check chromogranin A (CgA) levels
2. Obtain a CT scan
3. Repeat upper endoscopy for endoscopic resection of the lesions
4. Refer for genetic testing for multiple endocrine neoplasia type 1 (MEN 1)

QUESTION 2

A 65-year-old man with several months of intermittent flushing and chronic loose stools is admitted to the hospital due to abdominal pain and concern over a partial small bowel obstruction. CT of the abdomen reveals a 1 cm lesion in the distal terminal ileum within 10 cm of the ileocecal valve, with tethering of the small bowel adjacent, as well as suspicious lesions in the liver. The patient is managed conservatively and improves enough to handle oral intake. What is the best management strategy for this patient?

1. Perform a colonoscopy with ileal intubation for resection of the lesion
2. Perform a surgical resection with examination of the remainder of the bowel
3. Obtain an octreotide scan
4. Check cCgA levels

QUESTION 3

Which of the following is true regarding gastric NETs?

1. Type 2 gastric NETs represent the most common type of gastric NETs
2. Type 3 gastric NETs are associated with hypergastrinemia
3. Type 1 gastric NETs have a high risk of lymph node metastasis at time of diagnosis
4. Type 3 gastric NETs tend to be unifocal on presentation