Clin Endosc.  2022 May;55(3):381-389. 10.5946/ce.2021.242.

Outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms in patients with liver cirrhosis

• Choi YK
• Noh JH
• Kim DH
• Na HK
• Ahn JY
• Lee JH
• Jung KW
• Choi KD
• Song HJ
• Lee GH
• Jung HY

• KMID: 2529960
• DOI: http://doi.org/10.5946/ce.2021.242

Abstract

Background/Aims
The treatment of superficial esophageal neoplasms (SENs) in cirrhotic patients is challenging and rarely investigated. We evaluated the outcomes of endoscopic submucosal dissection (ESD) to determine the efficacy and safety of treating SENs in patients with liver cirrhosis.
Methods
The baseline characteristics and treatment outcomes of patients who underwent ESD for SENs between November 2005 and December 2017 were retrospectively reviewed.
Results
ESD was performed in 437 patients with 481 SENs, including 15 cirrhotic patients with 17 SENs. En bloc resection (88.2% vs. 97.0%) and curative resection (64.7% vs. 78.9%) rates were not different between the cirrhosis and non-cirrhosis groups (p=0.105 and p=0.224, respectively). Bleeding was more common in cirrhotic patients (p=0.054), and all cases were successfully controlled endoscopically. The median procedure and hospitalization duration did not differ between the groups. Overall survival was lower in cirrhotic patients (p=0.003), while disease-specific survival did not differ between the groups (p=0.85).
Conclusions
ESD could be a safe and effective treatment option for SENs in patients with cirrhosis. Detailed preprocedural assessments are needed, including determination of liver function, esophageal varix status, and remaining life expectancy, to identify patients who will obtain the greatest benefit.

Keyword

Squamous cell carcinoma; Endoscopic submucosal dissection; Esophageal neoplasms; Liver cirrhosis

Figure

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  Fig. 1. Clinical course of cirrhotic patients with non-curative resection. SEN, superficial esophageal neoplasm; RT, radiation therapy; ESD, endoscopic submucosal dissection.

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  Fig. 2. Clinical course of cirrhotic patients with curative resection. SEN, superficial esophageal neoplasm; EMR, endoscopic mucosal resection; ESD, endoscopic submucosal dissection.

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  Fig. 3. (A) Overall survival after endoscopic submucosal dissection. (B) Disease-specific survival after endoscopic submucosal dissection. LC, liver cirrhosis.

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