Post written by Ji Yong Ahn, MD, and Young Kwon Choi, MD, from the Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
We compared the clinical outcomes of ESD for gastric neoplasms between cirrhosis and noncirrhosis patients. In addition, we analyzed the Child–Pugh classification status before and after ESD in cirrhosis patients.
Endoscopic submucosal dissection (ESD) has several advantages as it is more convenient and less invasive than surgery for treating gastric adenoma and early gastric cancer. Considering the high prevalence of gastric cancer in liver cirrhosis (LC) patients, it is essential to determine whether ESD can be safely performed without high adverse event rates in this patient group. However, only a few studies with small sample sizes have examined this topic to date. Because of the insufficient reporting of the clinical outcomes of ESD, clinicians remain uncertain and hesitant about performing this procedure in LC patients.
Clinical outcomes of ESD for gastric neoplasms between 158 cirrhosis patients and 158 noncirrhosis patients were compared. Almost all (153 out of 158) of the patients in the cirrhosis group had early liver cirrhosis classified as Child–Pugh class A. Child–Pugh class rarely changed before and after the ESD procedure.
Short-term outcomes including en bloc resection and curative resection rates were similar between 2 groups. And adverse event rates including bleeding, the most concerning adverse event because of coagulopathy and low platelet count in cirrhosis patients, and perforation in the compensated cirrhosis group were not significantly different from those in the noncirrhosis group. Regarding long-term outcomes, cirrhosis without hepatocellular carcinoma patients showed comparable overall survival to noncirrhosis patients.
Therefore, the current study demonstrated that compensated cirrhosis patients without hepatocellular carcinoma at baseline can undergo ESD safely without experiencing a deterioration in liver function and that the clinical and oncologic outcomes are comparable with those for noncirrhosis patients.
Endoscopic resection for gastric neoplasm can be considered as a good treatment modality in Child–Pugh class A liver cirrhosis patients. However, in other conditions such as hepatocellular carcinoma or decompensated cirrhosis, the decision on procedure should be determined very carefully.
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