Clinical outcomes of endoscopic submucosal dissection for superficial esophageal neoplasia in close proximity to esophageal varices: a multicenter international experience

Abstract

Background: There is limited data on the feasibility of ESD for superficial esophageal neoplasia[SEN] located at or adjacent to esophageal varices [EV]. We aimed to evaluate the outcomes of ESD in these patients. Methods: This multicenter, retrospective study included cirrhotic patients with history of EV with SEN, located at or adjacent to EV and underwent ESD. Results: 23 patients with SEN [median lesion size 30mm], 16 squamous cell neoplasia, or 7 Barrett’s esophagus related neoplasia were included. Majority were Child Pugh B [56.5%] and had small EV [86%]. En bloc, R0 and curative resection was achieved in 95.6%, 91.3% and 82.6%. Severe intraprocedural bleeding [4.3%] and delayed bleeding [4.3%]were successfully treated endoscopically. No delayed perforation, hepatic decompensation or deaths were observed. During a median follow-up of 36 months[Interquartile range : 22-55], 1 case of local recurrence occurred after non-curative resection. Conclusion: ESD is feasible and effective for SEN located at or adjacent to EV in cirrhotic patients. Albeit, majority of the EV in our study were small in size, when expertise is available, ESD should be considered as a viable option for these patients.