Outcomes of ESD for patients with early gastric cancer and comorbid liver cirrhosis: a propensity score analysis

Abstract

LC patients appear to be good candidates for ESD if they have CP-A liver function and no history of HCC. Although their short-term outcomes were not inferior, the patients with Child-Pugh grades B/C or with histories of HCC benefited less from ESD.

Long-term outcome of endoscopic submucosal dissection for early gastric cancer in patients with severe comorbidities: a comparative propensity score analysis

“…However, a poorer prognosis is anticipated in patients with severe comorbidities even if successful treatment is achieved. Recently, results similar to ours were reported [8,10,11]. One multicenter retrospective cohort study [8], using propensity score analysis, demonstrated that 5-year overall survival rates of patients with liver cirrhosis was 60.0%, which was significantly lower than that of patients without liver cirrhosis (91.0%).…”

“…First, this study has sufficient median follow-up duration, 77.3 months in ASA-PS group 1/2 and 67.8 months in ASA-PS group 3, compared with previous studies (33.4-64.0 months) [8,10,11]. Secondly, this study also has a large sample size when Table 2 The cause of death and adverse events before and after propensity score matching Other cancers were detected during the follow-up period after ESD, although patients with history of another malignancy before ESD were excluded ASA-PS American Society of Anesthesiologist Physical Status, pulmonary disease (pneumonia, interstitial pneumonia, respiratory failure), cardiovascular disease (heart failure, ischemic heart disease, aortic dissection), cerebrovascular disease (hemorrhage, infarction), Other types of cancers (after ESD) (colon, lung, liver, bile duct), other diseases (esophageal varix rupture, acute peritonitis, hypoglycemia, senility, accident) a The number of patients who contracted each disease as a comorbidity on treatment and died of the same disease Before matching (n = 488) After matching (n = 178) compared to previous reports [8,10,11]. Thirdly, we demonstrated that the ASA-PS group 3 was an independent risk factor for overall mortality and resulted in shorter patient survival when adjusted for other confounding factors using propensity score matching and IPTW methods.…”

“…Therefore, similar results might also be expected in the excluded patients with ASA-PS 3. In previous reports regarding the long-term outcomes in patients with severe comorbidities [8,10,11], those with a short observation period were included in the Kaplan-Meier curves. However, the 5-year survival rates in our study may be more accurate because of its longer follow-up duration compared with those in other studies.…”

“…Consequently, many studies [1][2][3][4][5][6][7] have reported favorable short-and longterm outcomes for gastric ESD. In addition, ESD has also been performed on patients with severe comorbidities, such as liver cirrhosis or renal dysfunction, as well as in elderly patients because it is less invasive [8,9]. Some studies [10,11] have also reported on the long-term outcome of gastric ESD for patients with severe comorbidities.…”

Efficacy of vonoprazan for the prevention of bleeding after gastric endoscopic submucosal dissection with continuous use of antiplatelet agents

“…Endoscopic submucosal dissection (ESD) has become a standard therapy for gastric epithelial neoplasia after the implementation of technical skills and instrumentation [1]. The minimal invasiveness and organ-preserving nature of this technique have allowed for broader applications in higher risk patients such as elderly patients and those with severe comorbidities [2][3][4]. An increase in the ageing population has been associated with a rise in the number of individuals on antithrombotic therapy.…”