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
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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