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

Kolb, Jennifer M.; Wani, Sachin; Soetikno, Roy; Edmundowicz, Steven A.; Hammad, Hazem

doi:10.1055/a-1216-0148

Cited by 5 publications

(4 citation statements)

References 5 publications

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“…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

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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.

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Section: Discussionmentioning

confidence: 99%

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

2023

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“…These indicators showed good predictive efficiency. Due to the occupying effect of liver tumors and the destruction of the vascular system, HCC patients with cirrhosis have a higher risk of developing EGV than those with cirrhosis only [17,18]. This study is the first to establish a nomogram model for this special population.…”

Section: Discussionmentioning

confidence: 99%

Nomogram model for predicting esophsagogastric varices in hepatocellular carcinoma with cirrhosis

Zhang

Deng

Guo

et al. 2022

European Journal of Gastroenterology &Amp; Hepatology

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Background/aims The prognosis for hepatocellular carcinoma (HCC) with cirrhosis is poor. The risk of death also increases in patients with esophagogastric varices (EGV). Based on routine clinical features and related noninvasive parameters, a nomogram prediction model was developed in this study to facilitate the early identification of EGV in HCC patients. Methods A retrospective cohort analysis of patients with HCC in the Renmin Hospital of Wuhan University from 2020 to 2021 was performed. Clinical and noninvasive parameters closely related to EGV risk were screened by univariate and multivariate logistic regression analysis and integrated into a nomogram. The nomogram was validated internally and externally by calibration, receiver operating characteristic curve and decision curve analysis (DCA).Results A total of 165 patients with HCC-related cirrhosis were recruited. In the raining cohort, multivariate logistic regression analysis identified platelet (PLT) [odds ratio (OR), 0.950; 95% confidence interval (CI), 0.925-0.977; P < 0.001], D-dimer (OR. 3.341; 95% CI, 1.751-6.376, P < 0.001), spleen diameter (SD) (OR, 2.585; 95% CI, 1.547-4.318; P < 0.001) as independent indicators for EGV. The nomogram for predicting EGV risk was well calibrated with a favorable discriminative ability and an area under curve of 0.961. In addition, the nomogram showed better net benefits in the DCA. The results were validated in the validation cohort. Conclusions The proposed nomogram model based on three indicators (PLT, D-dimer and SD) showed an excellent predictive effect, leading to the avoidance of unnecessary esophagogastroduodenoscopy.

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“…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%

“…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 ]. At the same time, it also causes disappearance of the varices, probably related to shutting off their feeding vessels [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Endoscopic management of esophageal and gastric lesions with underlying varices

Dias¹

2022

aog

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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.

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

Cited by 5 publications

References 5 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

Nomogram model for predicting esophsagogastric varices in hepatocellular carcinoma with cirrhosis

Endoscopic management of esophageal and gastric lesions with underlying varices

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