Endoscopic Submucosal Dissection of Superficial Esophageal Neoplasms Is Feasible and Not Riskier for Patients with Liver Cirrhosis
Autor: | Kuang-I Fu, Mu-Shien Lee, Yung-Kuan Tsou, Ming-Yao Su, Ken Ohata, Chia-Yuan Liu, Cheng Hui Lin, Cheng-Tang Chiu |
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Jazyk: | angličtina |
Předmět: |
Liver Cirrhosis
Male Operating Rooms Cirrhosis Esophageal Neoplasms Physiology Blood Loss Surgical Gastroenterology Severity of Illness Index Endosonography 0302 clinical medicine Esophageal varices Superficial esophageal neoplasm Margins of Excision Middle Aged Endoscopic submucosal dissection Tumor Burden medicine.anatomical_structure 030220 oncology & carcinogenesis Carcinoma Squamous Cell 030211 gastroenterology & hepatology Original Article Female Esophageal Squamous Cell Carcinoma Esophagoscopy Liver dysfunction Adult medicine.medical_specialty Endoscopic Mucosal Resection Perforation (oil well) Postoperative Hemorrhage Esophageal and Gastric Varices 03 medical and health sciences Esophagus Internal medicine medicine Humans Neoplasm Invasiveness International Normalized Ratio Aged Retrospective Studies Esophageal Perforation business.industry Platelet Count En bloc resection Hepatology medicine.disease Case-Control Studies business |
Zdroj: | Digestive Diseases and Sciences |
ISSN: | 0163-2116 |
DOI: | 10.1007/s10620-016-4342-8 |
Popis: | Background Esophageal endoscopic submucosal dissection (ESD) has rarely been reported for the treatment of cirrhotic patients. Aim To report the results of ESD treatment of superficial esophageal neoplasms (SENs) for cirrhotic patients. Methods Forty patients with 50 consecutive SENs undergoing 46 sessions of ESD were retrospectively reviewed. The cirrhotic group included eight patients (11 SENs) with liver cirrhosis consisting of six patients classified as Child-Pugh class A liver cirrhosis and two patients classified as class B liver cirrhosis. Four patients (6 SENs) had coexisting esophageal varices. Parameters were compared between the cirrhotic patients and the non-cirrhotic controls (32 patients, 39 SENs). Results Platelet counts of the cirrhotic group were significantly lower, while international normalized ratio was significantly higher. When the cirrhotic group and non-cirrhotic group were compared, the mean tumor length (4 vs. 3.7 cm, p = 0.56) and median procedure time (15.1 vs. 11.5 min/cm2, p = 0.30) were similar. The en bloc resection rates were 81.8 and 89.7 % (p = 0.60). Within the cirrhotic group, both lesions without en bloc resection were patients with esophageal varices. The rates of submucosal disease for the cirrhotic group and non-cirrhotic groups were 54.5 and 25.6 % (p = 0.064), respectively, while the R0 resection rates were 77.8 and 94.3 % (p = 0.16), respectively. The two lesions without R0 resection in cirrhotic group had positive vertical but not horizontal margins due to submucosal invasion. Intraprocedural bleeding occurred more frequently in cirrhotic patients than non-cirrhotic patients (18.2 vs. 0 %, p = 0.045). None of the patients suffered from esophageal perforation, postoperative bleeding, or death that was related to the ESD. Conclusion Esophageal ESD seems to be safely and can be effectively performed on cirrhotic patients, particularly those without severe liver dysfunction. |
Databáze: | OpenAIRE |
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