Background: Neuroendocrine tumours (NET) arising from the small bowel are clinically challenging and are often diagnosed at advanced stages. Disease control with surgery alone can be demanding. Multimodal treatment concepts integrating surgery and non-surgical modalities could be of benefit. Method: Retrospective review of consecutive adult patients with SB NET treated at Imperial College Healthcare NHS Trust between 1 January 2010 and 31 December 2019. Data regarding clinicopathological characteristics, treatments, and disease trajectory were extracted and summarised. Overall and progression/recurrence-free survival were estimated at 5 and 10 years. Results: 154 patients were identified, with a median age of 64 years (range 33–87); 135/154 (87.7%) had stage III/IV disease at diagnosis. Surgery was used in 125 individuals (81.2%), typically with either segmental small bowel resection (60.8%) or right hemicolectomy (33.6%) and mesenteric lymphadenectomy for the primary tumour. Systemic and/or liver-directed therapies were used in 126 (81.8%); 60 (47.6%) had more than one line of non-surgical treatment. Median follow-up was 67.2 months (range 3.1–310.4); overall survival at 5 and 10 years was 91.0% (95% CI: 84.9–94.7%) and 82.5% (95% CI: 72.9–88.9%), respectively. Imaging-based median progression-free survival was 42.7 months (95% CI: 24.7 to 72.4); 5-year progression-free survival was 63.4% (95% CI: 55.0–70.6%); 10-year progression-free survival was 18.7% (95% CI: 12.4–26.1). Nineteen patients (12.3%) reached 10 years follow-up without disease recurrence and therefore were considered cured. Conclusions: Most patients with SB NET present in a metastasised stage. Multimodal treatment concepts may be associated with excellent clinical outcomes. Future work should explore optimal approaches to treatment sequencing and patient selection.

Neuroendocrine tumours (NETs) are relatively rare neoplasms but represent one of the most frequent types of primary small-bowel tumours. Their incidence is rising, and this is most likely because of their more frequent early-stage detection, physician awareness, and increasing availability and use of imaging and small-bowel endoscopic techniques, such as video capsule endoscopy and device-assisted enteroscopy, which enable the detection, localisation, and histological sampling of previously inaccessible and underdiagnosed small-bowel lesions. This review summarises the role of small-bowel endoscopy in the diagnosis and management of small-bowel NETs to assist clinicians in their practice. Small-bowel endoscopy may play a complementary role in the diagnosis of these tumours alongside other diagnostic tests, such as biomarkers, conventional radiology, and functional imaging. In addition, small-bowel enteroscopy may play a role in the preoperative setting for the identification and marking of these tumours for surgical resection and the management of rare complications, such as small-bowel variceal bleeding, in cases of portal hypertension due to the encasement of mesenteric vessels in fibrotic small-bowel NETs.

Video Capsule Endoscopycapsule endoscopy (VCE) has emerged as a minimally invasive diagnostic tool for detecting and monitoring small bowel involvement in polyposis syndromes. VCE is included in the surveillance guidelines of Peutz-Jeghers syndrome. In the remaining familial polyposis syndromes, VCE may facilitate the early detection of polyps, when indicated, particularly in areas beyond the reach of conventional endoscopy, thereby aiding timely detection. Colon capsule endoscopy has been studied in symptomatic, screening and polyp surveillance populations and the second-generation colon capsule has demonstrated excellent detection rates for advanced neoplasia, however its role in colonic polyposis requires further research. The role of the panenteric capsule has not been explored in polyposis syndromes as a panintestinal examination. Despite its advantages, VCE has notable limitations; it may miss small, flat, or hidden lesions and lacks the capability for tissue sampling or therapeutic intervention. In the future, advances in imaging technology, extended battery life, and the integration of artificial intelligence (AI) are expected to further enhance the utility of VCE. Our review aims to focus on the applications of VCE in polyposis syndromes and future perspectives.