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, 6 (1), 58-63

The Feasibility and Safety of the Endoscopic Submucosal Dissection of Superficial Gastric Neoplastic Lesions in Patients With Compensated Liver Cirrhosis: A Retrospective Study

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The Feasibility and Safety of the Endoscopic Submucosal Dissection of Superficial Gastric Neoplastic Lesions in Patients With Compensated Liver Cirrhosis: A Retrospective Study

Jong Hak Choi et al. Gut Liver.

Abstract

Background/aims: When undergoing endoscopic submucosal dissection (ESD), patients with liver cirrhosis (LC) may suffer from a high risk of bleeding, bacteremia and tissue vulnerability. There have been few reports evaluating the efficacy and safety of ESD in patients with LC.

Methods: From January 2004 to March 2010, 23 patients with LC (cirrhosis group) underwent ESD for superficial gastric neoplastic lesions. The number of patients with a liver function in the Child-Pugh classes A and B were 20 and 3, respectively. The clinical outcomes and complications were compared with 69 patients without LC (control group) that were matched for age and sex.

Results: The en bloc resection, R0 resection and en bloc plus R0 resection rates of the cirrhosis group were 82.6%, 91.3%, and 82.6%, respectively, and did not show significant differences from the rates of the control group. No local recurrence was found in either group during the follow-up period. The procedure length of time (41.0 vs 39.0 minutes), rate of bleeding (4.3% vs 7.2%) and rate of perforation (0.0% vs 1.4%) in the cirrhosis group were also comparable to the results from the control group.

Conclusions: ESD was safely performed in patients with LC, and satisfactory outcomes were achieved with high en bloc and R0 resection rates for superficial gastric neoplastic lesions.

Keywords: Endoscopic submucosal dissection; Liver cirrhosis; Superficial gastric neoplastic lesion.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
A case of a 60-year-old male patient with liver cirrhosis who underwent endoscopic submucosal dissection for early gastric cancer. His serum platelet count was 140×103/µL, and his Child-Pugh liver function classification was A (serum albumin, 3.5 g/dL; serum bilirubin, 1.7 mg/dL; prothrombin time in INR, 1.27). (A) Surface irregularity of the liver and marked gastric fundic varix (white arrow) is observed with abdominal computed tomography. (B) Gastric fundic varix is shown with upper endoscopy. (C) A 0.6-cm type 0-IIc lesion is observed at the lesser curvature side of the midbody. (D) A large, artificial, ulcer-induced after endoscopic submucosal dissection.

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