Endoscopic resection of early esophageal tumors in patients with cirrhosis or portal hypertension: a multicenter observational study

Mathilde Simonnot; Pierre H. Deprez; Mathieu Pioche; Eliane Albuisson; Timothée Wallenhorst; Fabrice Caillol; Stéphane Koch; Emmanuel Coron; Isabelle Archambeaud; Jérémie Jacques; Paul Basile; Ludovic Caillo; Thibault Degand; Vincent Lepilliez; Philippe Grandval; Adrian Culetto; Geoffroy Vanbiervliet; Marine Camus Duboc; Olivier Gronier; Carina Leal; Jérémie Albouys; Jean-Baptiste Chevaux; Maximilien Barret; Marion Schaefer

doi:10.1055/a-2085-3964

Endoscopy, Table of Contents

Endoscopy 2023; 55(09): 785-795
DOI: 10.1055/a-2085-3964

Original article

Endoscopic resection of early esophageal tumors in patients with cirrhosis or portal hypertension: a multicenter observational study

Mathilde Simonnot

¹Department of Gastroenterology, Nancy Regional University Hospital Center, Nancy, France

,

Pierre H. Deprez

²Hepatogastroenterology Department, Cliniques universitaires St-Luc, Université catholique de Louvain, Brussels, Belgium

,

Mathieu Pioche

³Gastroenterology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France

,

Eliane Albuisson

⁴DRCI, Department MPI, Data management and Statistics UMDS, Nancy Regional University Hospital Center , Nancy, France

,

Timothée Wallenhorst

⁵Department of Gastroenterology, Pontchaillou University Hospital, Rennes, France

,

Fabrice Caillol

⁶Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France

,

Stéphane Koch

⁷Department of Gastroenterology, Besançon Regional University Hospital Center, Besançon, France

,

Emmanuel Coron

⁸Institut de Maladies de l’Appareil Digestif, Hotêl Dieu University Hospital Center, Nantes, France

,

Isabelle Archambeaud

⁸Institut de Maladies de l’Appareil Digestif, Hotêl Dieu University Hospital Center, Nantes, France

,

Jérémie Jacques

⁹Hepato-Gastroenterology Department, Dupuytren University Hospital, Limoges, France

,

Paul Basile

¹⁰Digestive Endoscopy Unit, Gastroenterology Department, University Hospital of Rouen, Rouen, France

,

Ludovic Caillo

¹¹Gastroenterology Department, University Hospital of Nîmes, Nîmes, France

,

Thibault Degand

¹²Division of Gastroenterology, Dijon Bourgogne University Hospital, Dijon, France

,

Vincent Lepilliez

¹³Gastroenterology, Jean Mermoz Private Hospital, Lyon, France

,

Philippe Grandval

¹⁴Hepatogastroenterology Department, AP-HM, Hôpital La Timone, Marseille, France

,

Adrian Culetto

¹⁵Department of Gastroenterology, Toulouse University Hospital, Toulouse, France

,

Geoffroy Vanbiervliet

¹⁶Gastroenterology Department, L’Archet 2 University Hospital, Nice, France

,

Marine Camus Duboc

¹⁷Department of Endoscopy, Saint Antoine Hospital, Paris, France

,

Olivier Gronier

¹⁸Department of Gastroenterology and Hepatology, Clinique Sainte Barbe, Strasbourg, France

,

Carina Leal

²Hepatogastroenterology Department, Cliniques universitaires St-Luc, Université catholique de Louvain, Brussels, Belgium

,

Jérémie Albouys

⁹Hepato-Gastroenterology Department, Dupuytren University Hospital, Limoges, France

,

Jean-Baptiste Chevaux

¹Department of Gastroenterology, Nancy Regional University Hospital Center, Nancy, France

,

Maximilien Barret

¹⁹Department of Gastroenterology, Cochin Hospital, Paris, France

,

Marion Schaefer

¹Department of Gastroenterology, Nancy Regional University Hospital Center, Nancy, France

› Author Affiliations

Abstract

Background Liver cirrhosis and esophageal cancer share several risk factors, such as alcohol intake and excess weight. Endoscopic resection is the gold standard treatment for superficial tumors. Portal hypertension and coagulopathy may increase the bleeding risk in these patients. This study aimed to assess the safety and efficacy of endoscopic resection for early esophageal neoplasia in patients with cirrhosis or portal hypertension.

Methods This retrospective multicenter international study included consecutive patients with cirrhosis or portal hypertension who underwent endoscopic resection in the esophagus from January 2005 to March 2021.

Results 134 lesions in 112 patients were treated, including by endoscopic submucosal dissection in 101 cases (75 %). Most lesions (128/134, 96 %) were in patients with liver cirrhosis, with esophageal varices in 71 procedures. To prevent bleeding, 7 patients received a transjugular intrahepatic portosystemic shunt, 8 underwent endoscopic band ligation (EBL) before resection, 15 received vasoactive drugs, 8 received platelet transfusion, and 9 underwent EBL during the resection procedure. Rates of complete macroscopic resection, en bloc resection, and curative resection were 92 %, 86 %, and 63 %, respectively. Adverse events included 3 perforations, 8 delayed bleedings, 8 sepsis, 6 cirrhosis decompensations within 30 days, and 22 esophageal strictures; none required surgery. In univariate analysis, cap-assisted endoscopic mucosal resection was associated with delayed bleeding (P = 0.01).

Conclusions In patients with liver cirrhosis or portal hypertension, endoscopic resection of early esophageal neoplasia appeared to be effective and should be considered in expert centers with choice of resection technique, following European Society of Gastrointestinal Endoscopy guidelines to avoid undertreatment.

Full Text

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