A Pilot Experience of Endoscopic Submucosal Dissection of Barrett’s Dysplasia Despite Esophageal Varices and Decompensated Cirrhosis

Wang, Andrew Y.; Smith, Elliot; Sauer, Bryan G.; Henry, Zachary; Shah, Neeral L.; Caldwell, Stephen H.

doi:10.1002/hep.30850

Cited by 6 publications

(5 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In patients with gastroesophageal varices, the varices must be treated before endoscopic mucosal dissection, as serious adverse events have been reported to occur after endoscopic mucosal dissection ( 13 ). Endoscopic treatment of liver cirrhosis complicated by early esophageal or gastric cancer has been reported to be safe ( 14 , 15 ) Another retrospective study showed no significant difference in the incidence of complications after endoscopic mucosal dissection and no deterioration of liver function after endoscopic mucosal dissection in liver cirrhosis complicated with gastric tumors in different liver function groups ( 16 ). However, further research with more cases is needed to corroborate this.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic treatment of early esophageal cancer with decompensated cirrhosis and successful prevention of postoperative stenosis: A case report

2023

View full text Add to dashboard Cite

The management of gastrointestinal tumors with decompensated cirrhosis is extremely challenging. Patients often present with poor basic condition and coagulation function, and nutritional deficiency. Furthermore, postoperative recovery is difficult and so the majority of patients refuse surgery. The present study reports the case of a 73-year-old man with decompensated cirrhosis and early esophageal cancer. At the discretion of the patient and their family, a simultaneous approach was used to treat esophagogastric varices and perform a mucosal dissection of the early esophageal cancer via endoscopy. Post-surgery, multiple polyglycolic acid sheets were attached to the esophageal dissection wound. At >2 months post-surgery, an endoscopic re-examination of the patient showed that the esophageal mucosa had healed well, and there was no resistance detected via ordinary endoscopy. The main objective of the present study was to highlight the feasibility and safety of endoscopic treatment for patients with decompensated liver cirrhosis complicated with early esophageal cancer, and to provide a new treatment strategy for patients at high risk of esophageal stenosis after endoscopic mucosal dissection.

show abstract

Section: Discussionmentioning

confidence: 99%

Endoscopic treatment of early esophageal cancer with decompensated cirrhosis and successful prevention of postoperative stenosis: A case report

2023

View full text Add to dashboard Cite

show abstract

“…An alternative is to perform direct variceal coagulation during the procedure by grasping bared varices with hemostatic forceps and cauterizing them with soft coagulation. Several cases support the safety and effectiveness of this approach for early esophageal cancer with underlying varices [ 18 - 21 ]. Remarkably, it allowed extensive, even circumferential, esophageal ESD without significant bleeding [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, although most reported cases were performed with a platelet count >50,000/mL, in one case ESD was performed in a decompensated stage with severe thrombocytopenia (45,000/mL); there were no adverse events, suggesting that platelet count is not an absolute contraindication [ 19 ]. Another possible precautionary measure is to perform ESD under vasoactive therapy, which acts on the splanchnic circulation to decrease portal hypertension and alleviate collateral circulation, minimizing risk of bleeding [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Endoscopic management of esophageal and gastric lesions with underlying varices

Dias¹

2022

aog

View full text Add to dashboard Cite

Recent developments in endoscopic techniques have contributed to establishing endoscopy as an essential tool in the management of different types of esophageal and gastric lesions. However, management of these lesions with underlying varices is challenging, considering the technical difficulties and increased risk of bleeding it entails with current endoscopic techniques. Consequently, most endoscopists are hesitant to use this technically challenging procedure. Nevertheless, rare cases of successful endoscopic resection of superficial lesions on or adjacent to varices have been reported. Several endoscopic techniques, including endoscopic mucosal resection, endoscopic submucosal dissection or radiofrequency ablation, have demonstrated safety and feasibility in this setting, sometimes with technical modifications, or in combination with previous variceal eradication procedures that aim to decrease the risk of bleeding. In this review, we summarize the current evidence regarding endoscopic management of gastroesophageal lesions in patients with portal hypertension and underlying varices. It appears that liver cirrhosis, portal hypertension and gastroesophageal varices are not absolute contraindications in selected patients at specialized referral centers. Nevertheless, specific recommendations are lacking and further studies are needed to define the most appropriate endoscopic techniques and to determine which patients may be the best candidates.

show abstract

“…Histology revealed intramucosal adenocarcinoma (▶ Video 1). There are limited reports on esophageal [3,4] and gastric ESD [5] in patients with cirrhosis. We present the first case of circumferential esophageal ESD with direct variceal obliteration and the first reported Western case of gastric ESD in decompensated cirrhosis.…”

mentioning

confidence: 99%

Endoscopic submucosal dissection for early esophageal and gastric neoplasia in decompensated cirrhosis with varices

et al. 2020

View full text Add to dashboard Cite

A Pilot Experience of Endoscopic Submucosal Dissection of Barrett’s Dysplasia Despite Esophageal Varices and Decompensated Cirrhosis

Cited by 6 publications

References 3 publications

Endoscopic treatment of early esophageal cancer with decompensated cirrhosis and successful prevention of postoperative stenosis: A case report

Endoscopic treatment of early esophageal cancer with decompensated cirrhosis and successful prevention of postoperative stenosis: A case report

Endoscopic management of esophageal and gastric lesions with underlying varices

Endoscopic submucosal dissection for early esophageal and gastric neoplasia in decompensated cirrhosis with varices

Contact Info

Product

Resources

About