Outcomes of endoscopic submucosal dissection in cirrhotic patients: First American cohort  

作　　者：Robert Luke Pecha Fares Ayoub Ankur Patel Abdullah Muftah Michael W Wright Mai A Khalaf Mohamed O Othman 

机构地区：[1]Department of Gastroenterology and Hepatology,UC Davis,Sacramento,CA 95817,United States [2]Department of Gastroenterology and Hepatology,Baylor College of Medicine,Houston,TX 77030,United States [3]Internal Medicine,Baylor College of Medicine,Houston,TX 77030,United States [4]Department of Gastroenterology and Hepatology,University of Texas Medical Branch at Galveston,Galveston,TX 77550,United States [5]Medical School,Baylor College of Medicine,Houston,TX 77030,United States [6]Department of Tropical Medicine,Tanta University,Tanta 31527,Egypt

出　　处：《World Journal of Hepatology》2024年第5期784-790,共7页世界肝病学杂志（英文版）（电子版）

基　　金：reviewed and approved by the Baylor College of Medicine Institutional Review Board.

摘　　要：BACKGROUND Among patients with cirrhosis and pre-malignant or early malignant mucosal lesions,surgical intervention carries a much higher bleeding risk.When such lesions are discovered,endoscopic submucosal dissection(ESD)may offer curative therapy with lower risks than surgery and improved outcomes compared to traditional endoscopic resection.AIM To evaluate the outcomes of ESD in patients with cirrhosis.METHODS Patients with cirrhosis undergoing ESD between July 2015 and August 2022 were retrospectively matched in 1:2 fashion to controls based on lesion location,size,and anticoagulation use.Procedural outcomes were compared between groups.RESULTS A total of 64 Lesions from 59 patients were included(16 cirrhosis,43 control).There were no differences in patient or lesion characteristics between groups.En bloc and curative resection was achieved in 84.21%,78.94%of the cirrhosis group and 88.89%,68.89%of controls,respectively,with no significant differences.Cirrhotic patients had significantly higher rates of intra-procedural coagulation grasper use for control of bleeding(47.37%vs 20%;P=0.02).There were otherwise no significant differences in adverse event rates.In the 29 patients with follow up,we found higher rates of recurrence in the cirrhosis group compared to controls(40%vs 5.26%;P=0.019),however this effect did not persist on multivariable analysis controlling for known confounders.CONCLUSION ESD may be safe and effective in patients with cirrhosis.Most procedure related outcomes were not significantly different between groups.Intra-procedural bleeding requiring use of the coagulation grasper use was expectedly higher in the cirrhosis group given the known effects of liver disease on hemostasis.

关 键 词：Endoscopic aubmucosal dissection CIRRHOSIS Advanced polypectomy Intraprocedural bleeding Colon cancer 

分 类 号：R725.7[医药卫生—儿科]