This paper is only available as a PDF. To read, Please Download here.
ABSTRACT
Background and Aims
Treatment strategies for early cancers or precancerous lesions of the upper gastrointestinal
tract in cirrhotic patients with esophagogastric varices (EGV) are complicated and
risky. We aimed to assess the efficacy and safety of endoscopic submucosal dissection
(ESD) in the treatment of such patients and explore optimal treatment strategies.
Methods
We retrospectively enrolled 15 cirrhotic patients with EGV who underwent ESD for early
cancers or precancerous lesions of the upper gastrointestinal tract from January 2012
to December 2021 at our center. Clinical features, endoscopic findings, treatment
methods, adverse events and follow-up data were analyzed.
Results
Of the 15 patients, 1 had a platelet count <30×1000/mm3. Five were untreated for EGV, 1 was treated after ESD, 6 were treated before ESD,
1 was treated before and during ESD, and 2 were treated during ESD. The R0 resection
rate was 100%. Of the 16 mucosal lesions, 15 were ERB-0 or ERB-c1, and 1 was ERB-c2.
No patient experienced deterioration in liver function. The only adverse events were
fever in 2 patients and postoperative bleeding (PB) in 2 patients. During a median
follow-up of 27 months, 1 patient’s esophageal HGD recurred at 19 months. No death
resulted from the ESD procedure, liver function injury or gastrointestinal tumor itself.
Conclusion
ESD is an effective and safe treatment for early cancers or precancerous lesions of
the upper gastrointestinal tract in cirrhotic patients with EGV. The incidence of
severe adverse events is very low due to the development of individualized clinical
treatment strategies.
KEY WORDS
ABBREVIATIONS:
ALC (alcohol consumption), AMI (acute myocardial infarction), APC (argon plasma coagulation), DA (differentiated adenocarcinoma), DSCC (differentiated squamous cell carcinoma), EGV (esophagogastric varices), EHI (endoscopic histoacryl injection), EIS (endoscopic injection sclerotherapy), ERB (endoscopic resection bleeding), ESD (endoscopic submucosal dissection), EV (esophageal varices), EVL (endoscopic variceal ligation), GV (gastric varices), HBV (hepatitis B virus), HCV (hepatitis C virus), HGD (high-grade dysplasia), IB (intraoperative bleeding), INR (international normalized ratio), IQR (interquartile range), JSPH (Japan Society for Portal Hypertension), PB (postoperative bleeding), PVT (portal vein thrombosis), UL0 (ulcer-negative), UL1 (ulcer-positive)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gastrointestinal EndoscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
Article info
Publication history
Accepted:
January 11,
2023
Received in revised form:
December 20,
2022
Received:
October 20,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
AUTHOR CONTRIBUTION:
En-Qiang Linghu, Lian-Yong Li, Shuai Zhang and Ying-Di Liu made contributions to the conception and design of the study. En-Qiang Linghu, Ying-Di Liu, Ning-Li Chai performed the procedure. Shuai Zhang, Zhan-Di He, Lu Bai and Xin Huang undertook data collection and literature retrieval. Shuai Zhang, Ying-Di Liu, Ning-Li Chai, Yi Yao, Fei Gao, Bo Liu made analysis and interpretation of the data. Shuai Zhang and Chao Gao designed and drew the figures and tables. Shuai Zhang and Ying-Di Liu drafted the article. En-Qiang Linghu and Lian-Yong Li corrected the critical revision of the article for important intellectual content. All authors read and approved the final manuscript.
CONFLICT OF INTEREST: None declared.
DISCLOSURES: All authors disclosed no financial relationships relevant to this publication
Identification
Copyright
© 2023 by the American Society for Gastrointestinal Endoscopy
