Unraveling the characteristics of early esophageal neuroendocrine carcinoma using multi-model endoscopy: A retrospective study of serial cases.

BACKGROUND

Early esophageal neuroendocrine carcinoma (E-NEC) is a rare but aggressive malignancy with poorly understood endoscopic features. Despite advancements in multi-model endoscopy, including white light endoscopy, magnifying endoscopy narrow-band imaging (NBI), and endoscopic ultrasonography (EUS), the diagnostic characteristics of early E-NEC remain unclear. Comprehensive evaluation using these techniques can improve early detection and guide clinical management. This study aimed to investigate the endoscopic features of early E-NEC using multiple imaging modalities. We hypothesized that specific endoscopic patterns, such as irregular microvascular morphology or signs of submucosal invasion, could reliably distinguish early E-NEC from other esophageal lesions.

AIM: To characterize early E-NEC using multi-model endoscopy and identify diagnostic endoscopic features.

METHODS

Clinical data of four patients with esophageal submucosal lesions identified by gastroscopy and pathologically diagnosed as E-NEC in the Department of Gastroenterology, The First Affiliated Hospital of Zhejiang University School of Medicine between January 2020 and August 2024 were retrospectively analyzed, and their manifestations under multi-model endoscopy were observed. Grayscale values of ultrasound images in three patients with E-NEC and eight with esophageal leiomyoma were calculated using Image J software and compared using the Mann-Whitney U test.

RESULTS

Among the four patients with early E-NEC, two were males and two were females, with ages ranging from 60-70 years. White light endoscopy revealed three patients with mild local ulceration on the lesion surface. NBI images were available in two patients, revealing the intraepithelial papillary capillary loop of B1-B2 and B2 types. EUS was performed in three patients, all showing solitary hypoechoic lesions originating from the muscularis mucosa/mucosal muscular layer or submucosa; peripherally enlarged lymph node was observed in one patient. Average grayscale value of EUS images for early E-NEC (n = 3, 63.79 ± 1.42) was significantly higher than that for esophageal leiomyoma (n = 8, 49.44 ± 11.57; P = 0.01).

CONCLUSION

Endoscopic features of early E-NEC differ from those of esophageal leiomyoma, including NBI imaging, lymph node metastasis, and a notably higher echo intensity on EUS.