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Endoscopic submucosal dissection for early cancers or precancerous lesions of the upper gastrointestinal tract in cirrhotic patients with esophagogastric varices: Ten-year experience from a large tertiary center in China

Published:January 16, 2023DOI:https://doi.org/10.1016/j.gie.2023.01.023
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      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)
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