Advanced Endoscopic Resection Techniques in Cirrhosis—A Systematic Review and Meta-Analysis of Outcomes

Chandan, Saurabh; Deliwala, Smit; Khan, Shahab R.; Ramai, Daryl; Mohan, Babu P.; Bilal, Mohammad; Facciorusso, Antonio; Kassab, Lena L.; Kamal, Faisal; Dhindsa, Banreet; Perisetti, Abhilash; Adler, Douglas G.

doi:10.1007/s10620-021-07364-w

Cited by 7 publications

(5 citation statements)

References 69 publications

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“…However, ESD in patients with liver cirrhosis is challenging due to the presence of GOV, ascites, coagulation disorders and/or thrombocytopenia. A systematic review and meta-analysis revealed that pooled rates of immediate & delayed bleeding, perforation, and death during EMR and/or ESD in patients with cirrhosis were 9.5% (CI 4.0-21.1), 6.6% (CI 4.2-10.3), 2.1% (CI 1.1-3.9) and 0.6% (CI 0.2-1.7), with only immediate bleeding rate higher than that in general population [22]. A multicenter observational study enrolled 134 early esophageal tumor lesions in 112 patients with liver cirrhosis reported 3(2.7%) perforations, 8 (7.1%) delayed bleedings, 8 (7.1%) sepsis, 6 (5.4%) cirrhosis decompensations within 30 days and 22 (19.6%) esophageal strictures [15].…”

Section: Discussionmentioning

confidence: 83%

Endoscopic Submucosal Dissection for Treatment of Early-Stage Cancer or Precancerous Lesion of the Upper Gastrointestinal Tract in Patients with Liver Cirrhosis

Tan,

Qing,

et al. 2023

Preprint

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(1) Background: Endoscopic submucosal dissection (ESD) has been widely accepted as the standard method for treating early-stage cancer or precancerous lesions in the upper gastrointestinal tract, however it may be difficult in patients with liver cirrhosis due to coagulation dysfunction or presence of gastroesophageal varices. We aimed to demonstrate the safety and efficacy of ESD in these population. (2) Methods: We retrospectively collected the clinical data and analyzed. Patients inclusion criteria: 1) patients with liver cirrhosis; 2) patients who underwent ESD; 3) patients diagnosed of early-stage cancer or precancerous lesions in the upper gastrointestinal tract. (3) Results: Eight patients were enrolled from April 2019 to April 2023, of whom 3 were male and 5 female, with age ranging from 43 to 70 years old. Seven lesions were located in the stomach, and the other one lesion in the esophagus. ESD was performed successfully in all patients, and the resected lesion size ranged from 2 to 6 cm. Only one patient encountered postoperative complication, chest pain and fever. No recurrence of noticed during a follow-up of 6 to 36 months. (4) Conclusions: ESD is safe and effective for treating upper gastrointestinal early-stage cancer or precancerous lesions in patients with liver cirrhosis.

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Section: Discussionmentioning

confidence: 83%

Endoscopic Submucosal Dissection for Treatment of Early-Stage Cancer or Precancerous Lesion of the Upper Gastrointestinal Tract in Patients with Liver Cirrhosis

Tan,

Qing,

et al. 2023

Preprint

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“…Other small studies have evaluated primarily gastric and esophageal ESD in cirrhotic and have found similar findings, with no significant difference in bleeding[ 12 , 21 , 22 ]. One meta-analysis that included 319 patients who underwent ESD evaluated outcomes among patients with cirrhosis who underwent both EMR or ESD and reported pooled data[ 23 ]. Delayed (LP1) bleeding, perforation, and short-term mortality were equivalent, but rates of immediate bleeding between cirrhosis and non-cirrhosis patients were significantly different [13.3% vs 5.2%, relative risk 1.57 (95%CI: 1.2-2.1)].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of endoscopic submucosal dissection in cirrhotic patients: First American cohort

Pecha,

Ayoub,

Patel

et al. 2024

World J Hepatol

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BACKGROUND Among patients with cirrhosis and pre-malignant or early malignant mucosal lesions, surgical intervention carries a much higher bleeding risk. When such lesions are discovered, endoscopic submucosal dissection (ESD) may offer curative therapy with lower risks than surgery and improved outcomes compared to traditional endoscopic resection. AIM To evaluate the outcomes of ESD in patients with cirrhosis. METHODS Patients with cirrhosis undergoing ESD between July 2015 and August 2022 were retrospectively matched in 1:2 fashion to controls based on lesion location, size, and anticoagulation use. Procedural outcomes were compared between groups. RESULTS A total of 64 Lesions from 59 patients were included (16 cirrhosis, 43 control). There were no differences in patient or lesion characteristics between groups. En bloc and curative resection was achieved in 84.21%, 78.94% of the cirrhosis group and 88.89%, 68.89% of controls, respectively, with no significant differences. Cirrhotic patients had significantly higher rates of intra-procedural coagulation grasper use for control of bleeding (47.37% vs 20%; P = 0.02). There were otherwise no significant differences in adverse event rates. In the 29 patients with follow up, we found higher rates of recurrence in the cirrhosis group compared to controls (40% vs 5.26%; P = 0.019), however this effect did not persist on multivariable analysis controlling for known confounders. CONCLUSION ESD may be safe and effective in patients with cirrhosis. Most procedure related outcomes were not significantly different between groups. Intra-procedural bleeding requiring use of the coagulation grasper use was expectedly higher in the cirrhosis group given the known effects of liver disease on hemostasis.

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“…However, ESD in patients with liver cirrhosis is challenging due to the presence of GOV, ascites, poor tolerance of anesthesia, coagulation disorders, and/or thrombocytopenia. A systematic review and meta-analysis revealed that the pooled rates of immediate and delayed bleeding, perforation, and death during EMR and/or ESD in patients with cirrhosis were 9.5%, 6.6%, 2.1%, and 0.6%, with only an immediate bleeding rate higher than that of the general population [28]. A multicenter observational study that enrolled 134 early esophageal tumorous lesions in 112 patients with liver cirrhosis reported 3 (2.7%) perforations, 8 (7.1%) delayed bleedings, 8 (7.1%) instances of sepsis, 6 (5.4%) cirrhosis decompensations within 30 days, and 22 (19.6%) esophageal strictures [17].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Submucosal Dissection for Treatment of Early-Stage Cancer or Precancerous Lesion in the Upper Gastrointestinal Tract in Patients with Liver Cirrhosis

Tan,

Qing,

Liu

et al. 2023

JCM

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(1) Background: Endoscopic submucosal dissection (ESD) has been widely accepted as the standard method for treating early-stage cancer or precancerous lesions in the upper gastrointestinal tract; however, it may be difficult in patients with liver cirrhosis due to clinical challenges such as coagulation dysfunction, presence of gastroesophageal varices, etc. We aimed to demonstrate the safety and efficacy of ESD in these populations. (2) Methods: The clinical data of patients were retrospectively collected and analyzed. Inclusion criteria of the study were: a. patients with liver cirrhosis; b. patients who underwent ESD; c. patients who were diagnosed with early-stage cancer or precancerous lesions in the upper gastrointestinal tract. (3) Results: Eight patients were enrolled from April 2019 to April 2023, of whom three were male and five were female, with ages ranging from 43 to 70 years old. Seven lesions were located in the stomach and one other lesion was in the esophagus. ESD was performed successfully in all eight patients, and the resected lesion size ranged from 2 to 6 cm. Only one patient encountered postoperative complications, namely, chest pain and fever. No recurrence was noticed during a follow-up of 3 to 45 months. (4) Conclusions: ESD may serve as a safe and effective method for treating upper gastrointestinal early-stage cancer or precancerous lesions in patients with liver cirrhosis.

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Advanced Endoscopic Resection Techniques in Cirrhosis—A Systematic Review and Meta-Analysis of Outcomes

Cited by 7 publications

References 69 publications

Endoscopic Submucosal Dissection for Treatment of Early-Stage Cancer or Precancerous Lesion of the Upper Gastrointestinal Tract in Patients with Liver Cirrhosis

Endoscopic Submucosal Dissection for Treatment of Early-Stage Cancer or Precancerous Lesion of the Upper Gastrointestinal Tract in Patients with Liver Cirrhosis

Outcomes of endoscopic submucosal dissection in cirrhotic patients: First American cohort

Endoscopic Submucosal Dissection for Treatment of Early-Stage Cancer or Precancerous Lesion in the Upper Gastrointestinal Tract in Patients with Liver Cirrhosis

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