Dataset Information

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

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).

Conclusion

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.

SUBMITTER: Choi YK

PROVIDER: S-EPMC9178137 | biostudies-literature | 2022 May

REPOSITORIES: biostudies-literature

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Publications

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

Choi Young Kwon YK Noh Jin Hee JH Kim Do Hoon DH Na Hee Kyong HK Ahn Ji Yong JY Lee Jeong Hoon JH Jung Kee Wook KW Choi Kee Don KD Song Ho June HJ Lee Gin Hyug GH Jung Hwoon-Yong HY

Clinical endoscopy 20220420 3

<h4>Background/aims</h4>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.<h4>Methods</h4>The baseline characteristics and treatment outcomes of patients who underwent ESD for SENs between November 2005 and December 2017 were retrospectively reviewed.<h4>Results</h4>ESD was p ...[more]

PMID: 35656629

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Project description:BackgroundThere is limited reporting of treatment options for early esophageal squamous cell carcinoma in esophageal-gastric fundal varices patients. Historically, surgery is the preferred treatment for squamous cell carcinoma; however, esophagectomy is associated with higher complications and death rates. The difficulty of such an operation was the varicose veins around the mucosa of the lesion. Possibility of concomitant intraoperative fatal bleeding. Previous studies have proved the effectiveness of endoscopic mucosal resection (EMR) paired with endoscopic injection sclerotherapy (EIS) for treating early esophageal cancers on esophageal varices.Case descriptionWe reported an effective endoscopic treatment of such conditions in a 62-year-old man with liver cirrhosis. After seeking informed consent, we performed endoscopic submucosal dissection (ESD) of early esophageal squamous cell carcinoma after the eradication of esophageal-gastric fundal varices using EIS. The resection margins indicated negative for carcinoma and dysplasia, suggesting that no recurrence and complication occurred. The patient was discharged 5 days after ESD without any complications including perforation or bleeding. No complaint from the patient was received during the 1-week follow-up, and the patient was tolerating solid food. The pathological result of the two lesions both showed moderately differentiated squamous cell carcinoma of the esophagus, T1bN0M0. The resection margins suggested negative for both carcinoma and dysplasia according to pathological examination. There was no recurrence or adverse event during follow-up.ConclusionsOur case presented the successful treatment of esophageal squamous cell carcinoma on esophageal-gastric fundal varices. This indicated that patients with cirrhosis and portal hypertension could also be treated with ESD, which could reduce trauma and discomfort and improve their quality of life. We recommend future studies to further investigate the indications of using endoscopic treatment for patients with cirrhosis.

Project description:BackgroundEsophageal cancer is one of the leading causes of morbidity and mortality across the world. Only one systematic review and meta-analysis has attempted to compare the morbidity and mortality outcomes in superficial esophageal squamous cancer patients undergoing endoscopic submucosal dissection (ESD) and esophagectomy (ESO), but with several limitations. This study aimed at comparing the outcomes of hospital stay duration, procedure duration, recurrence, complications, all-cause mortality, short-term survival, and long-term survival in patients with superficial esophageal squamous cancer undergoing ESD and ESO.MethodsSix databases (Web of Science, PubMed, EMBASE, CENTRAL, Scopus, and MEDLINE) were systematically searched according to PRISMA guidelines for eligible studies. With the available literature, we conducted a random-effect meta-analysis to evaluate weighted effect size and odds ratios to determine the comparative morbidity and mortality outcomes between patients with superficial esophageal squamous cancer undergoing ESD and ESO.ResultsWe found 16 eligible studies detailing 5,213 and 8,049 age- and sex-matched patients undergoing ESD and ESO, respectively. Meta-analysis revealed reduced hospital stay (Hedge's g: -1.22) and procedure duration (g: -4.54) for patients undergoing ESD. We also observed significantly reduced risks for complications (odds ratio: 0.35) and all-cause mortality (OR: 0.56) in patients undergoing ESD. Differences in recurrence (OR: 0.95), short-term outcomes (OR: 1.10), and long-term survival (OR: 0.81) outcomes were not significantly different between ESD and ESO.ConclusionsThis meta-analysis provides evidence concerning the improved morbidity and mortality outcomes in superficial esophageal squamous cancer patients undergoing ESD as compared to ESO. The findings herein may aid in developing clinical awareness and assisting best practice guideline development for managing superficial esophageal squamous cancer.RegistrationPROSPERO, https://www.crd.york.ac.uk/prospero/#searchadvanced, CRD42021286212.

Dataset Information

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

Background/aims

Methods

Results

Conclusion

Publications

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

Similar Datasets

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