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

Abstract

(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.

Lesion size affects the risk of technical difficulty in gastric endoscopic submucosal dissection

“…Perhaps this phenomenon is related to the difference in the incidence of early gastric cancer between eastern and western countries 24 , 26 . Another important factor is that two or more lesions in these studies are resected during the same procedure, which would increase the endoscopist's fatigue and susceptibility to perforation or bleeding, as well as increase the incidence of adverse cardiovascular events by prolonging anesthesia duration 11 , 27 , 28 . Based on these concerns, our study excluded cases with the non-single lesion to more rigorously analyze the relationship between lesion size and technical difficulty.…”

“…The absolute and expanded criteria of endoscopic therapy and detailed ESD procedures have been widely described 9 – 11 . To summarize, the protocol consists of 5 steps: (1) marking dots around the lesion; (2) submucosal injection of a solution; (3) mucosal incision with a dual knife and submucosal dissection with a dual knife in epithelial lesions or an IT knife in non-epithelial lesions; (4) coagulating visible vessels; and (5) retrieval of the specimen (Fig.…”