Step‐by‐step approach to the incidental diagnosis of type I gastric neuroendocrine tumors: practical insights

Objective: The incidental diagnosis of type I gastric neuroendocrine tumors (gNETs) has become increasingly frequent in clinical practice, largely due to the widespread use of upper gastrointestinal endoscopy and improved recognition of these lesions. Although typically indolent, type I gNETs require accurate assessment to ensure appropriate risk stratification, management, and follow-up. This review provides a practical, evidence-based guide specifically designed for gastroenterologists and clinicians managing patients with incidentally discovered type I gNETs. Methods: Structured in a step-by-step format, the review outlines key aspects of diagnosis and management, including endoscopic recognition and differential diagnosis, histological confirmation with a focus on corpus-restricted atrophic gastritis, initial risk assessment based on tumor characteristics and patient factors, and the use of additional imaging modalities such as endoscopic ultrasound, cross-sectional imaging, and functional imaging. Results: The review emphasizes the importance of referring patients to specialized centers for multidisciplinary evaluation, a strategy shown to improve clinical outcomes and adherence to best practices. Finally, practical recommendations for long-term surveillance are provided, with clear indications tailored to individual patient risk profiles. Conclusion: By integrating current guidelines with practical insights and highlighting critical decision points, this review serves as a concise, user-friendly tool to support clinicians in optimizing the care of patients with type I gastric NETs. This stepwise approach aims to bridge the gap between complex guideline recommendations and daily clinical practice, offering actionable guidance to ensure safe, effective, and standardized management of these increasingly encountered lesions.