Safe and effective digestive endoscopic resection in patients with cirrhosis: a single-center experience

Abstract

Background Endoscopic resection has developed over the years. The main complications are perforation and bleeding. This study aimed to evaluate safety and effectiveness of digestive endoscopic resection in patients with cirrhosis. Methods This retrospective, open-label, single-center study included all consecutive patients with cirrhosis who were admitted for endoscopic resection between 2009 and 2016. Safety, efficacy, and risk factors for delayed bleeding were analyzed. Results 126 patients undergoing 164 procedures were included: 65 endoscopic resections (49 patients) in the upper gastrointestinal tract (esophagus 34, stomach 20, duodenum 11) and 99 in the lower gastrointestinal tract (77 patients). Mean Model for End-Stage Liver Disease score was 9.9 (standard deviation 4.5). Esophageal varices were present in 50 patients, and 21 patients had decompensated cirrhosis. The overall curative rate of endoscopic resection was 84.0 %. No patients died during 30-day follow-up. Immediate overall morbidity was 6.1 %, with two postoperative fevers and eight bleeds. Risk factors for delayed bleeding were duodenal location (P < 0.01), antiplatelet medication (P = 0.02), and lower glomerular filtration rate (GFR) (P = 0.01) in univariate analysis. Duodenal location and lower GFR remained statistically significant in multivariate analysis, with respective odds ratios for bleeding of 52.12 and 1.04. No liver decompensation occurred after endoscopic resection. Conclusions Endoscopic resection was safe and effective in patients with mild (Child – Pugh class A/B) cirrhosis, and should be proposed as a first option for treatment of superficial neoplasia. Additional data in patients with severe cirrhosis are needed to confirm the safety in this population.

Associations Between Endoscopic Primary Prophylaxis and Rebleeding in Liver Cirrhosis Patients with Esophagogastric Variceal Bleeding

“…Additionally, the effect of endoscopic primary prophylaxis in decreasing the risk of rebleeding was better in the Grade A group than in the Grade B group. Endoscopic primary prophylaxis had no significant effects for Grade C patients because these patients had poor coagulation function, liver function, and nutritional status; the endoscopic treatment may increase the risk of bleeding, and it is difficult for them to recover after surgery ( 31 ). Therefore, clinicians might apply endoscopic primary prophylaxis based on the Child Pugh of patients.…”

Endoscopic submucosal tunnel dissection for early esophageal squamous cell carcinoma in patients with cirrhosis: A propensity score analysis

“…However, EESCC usually has a good prognosis after endoscopic resection, with a 5-year survival rate of more than 90% and a low incidence of complications[ 27 ]; thus, it is worth exerting effort for endoscopists to try it. In addition, based on current medical technology, it is difficult to predict which patients will survive longer and will really benefit from endoscopic surgery in the future[ 28 ]. Thirdly, cirrhotic patients are facing the need for further treatments to gain a better survival expectation in the future because their untreated cancer may preclude them from undergoing liver transplantation.…”

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

“…Pre-ESD transjugular intrahepatic portosystemic shunting carries procedural and hepatic encephalopathy risks. There are increasing data on the safety of endoscopic resection in patients with cirrhosis [2]. Case 1: A 62-year-old man with decompensated cirrhosis underwent endoscopy demonstrating grade II varices and Barrett's esophagus (C6M6), with a prominent 2-cm nodule (histology: adenocarcinoma) and multifocal nodularity (high grade dysplasia) with no other medical comorbidities (▶ Fig.…”