The Feasibility and Safety of the Endoscopic Submucosal Dissection of Superfi cial Gastric Neoplastic Lesions in Patients with Compensated Liver Cirrhosis: A Retrospective Study

Abstract

Background/AimsWhen undergoing endoscopic submucosal dissection (ESD), patients with liver cirrhosis (LC) may suffer from a high risk of bleeding, bacteremia and tissue vulnerability. There have been few reports evaluating the efficacy and safety of ESD in patients with LC.MethodsFrom January 2004 to March 2010, 23 patients with LC (cirrhosis group) underwent ESD for superficial gastric neoplastic lesions. The number of patients with a liver function in the Child-Pugh classes A and B were 20 and 3, respectively. The clinical outcomes and complications were compared with 69 patients without LC (control group) that were matched for age and sex.ResultsThe en bloc resection, R0 resection and en bloc plus R0 resection rates of the cirrhosis group were 82.6%, 91.3%, and 82.6%, respectively, and did not show significant differences from the rates of the control group. No local recurrence was found in either group during the follow-up period. The procedure length of time (41.0 vs 39.0 minutes), rate of bleeding (4.3% vs 7.2%) and rate of perforation (0.0% vs 1.4%) in the cirrhosis group were also comparable to the results from the control group.ConclusionsESD was safely performed in patients with LC, and satisfactory outcomes were achieved with high en bloc and R0 resection rates for superficial gastric neoplastic lesions.

Child-Pugh B or C Cirrhosis Increases the Risk for Bleeding Following Colonoscopic Polypectomy

“…LC severity was classified into categories of CP class A to C, based on each patient’s CP score (CP-A, 5–6 points; CP-B, 7–9 points; CP-C, 10–15 points). 19 This study adhered to the tenets of the Declaration of Helsinki. As the study did not include personal identifiers and was of a retrospective observational nature, informed consent was waived, and the study protocol was approved by the Seoul National University Hospital Institutional Review Board (IRB number: H-1807-042-957).…”

The Risk of Endoscopy-Related Bleeding in Patients with Liver Cirrhosis: A Retrospective Study

“…However, another study reported that the Child–Pugh score was an independent risk factor for bleeding during colonoscopic polypectomy and that the risk of immediate bleeding after polypectomy was high for patients with cirrhosis in the Child B and Child C groups [ 15 ]. Several studies on the upper gastrointestinal tract in cirrhotic patients have reported various bleeding rates during endoscopic submucosal dissection procedures, ranging from 4.3% to 16.7% [ 16 , 17 , 18 ]. It is not easy to determine the safety issues associated with endoscopic procedures in patients with cirrhosis.…”