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
1   Department of Gastroenterology, Nancy Regional University Hospital Center, Nancy, France
,
2   Hepatogastroenterology Department, Cliniques universitaires St-Luc, Université catholique de Louvain, Brussels, Belgium
,
Mathieu Pioche
3   Gastroenterology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
,
Eliane Albuisson
4   DRCI, Department MPI, Data management and Statistics UMDS, Nancy Regional University Hospital Center , Nancy, France
,
Timothée Wallenhorst
5   Department of Gastroenterology, Pontchaillou University Hospital, Rennes, France
,
Fabrice Caillol
6   Endoscopy Unit, Paoli-Calmettes Institute, Marseille, France
,
Stéphane Koch
7   Department of Gastroenterology, Besançon Regional University Hospital Center, Besançon, France
,
Emmanuel Coron
8   Institut de Maladies de l’Appareil Digestif, Hotêl Dieu University Hospital Center, Nantes, France
,
Isabelle Archambeaud
8   Institut de Maladies de l’Appareil Digestif, Hotêl Dieu University Hospital Center, Nantes, France
,
Jérémie Jacques
9   Hepato-Gastroenterology Department, Dupuytren University Hospital, Limoges, France
,
10   Digestive Endoscopy Unit, Gastroenterology Department, University Hospital of Rouen, Rouen, France
,
Ludovic Caillo
11   Gastroenterology Department, University Hospital of Nîmes, Nîmes, France
,
Thibault Degand
12   Division of Gastroenterology, Dijon Bourgogne University Hospital, Dijon, France
,
Vincent Lepilliez
13   Gastroenterology, Jean Mermoz Private Hospital, Lyon, France
,
Philippe Grandval
14   Hepatogastroenterology Department, AP-HM, Hôpital La Timone, Marseille, France
,
Adrian Culetto
15   Department of Gastroenterology, Toulouse University Hospital, Toulouse, France
,
16   Gastroenterology Department, L’Archet 2 University Hospital, Nice, France
,
Marine Camus Duboc
17   Department of Endoscopy, Saint Antoine Hospital, Paris, France
,
Olivier Gronier
18   Department of Gastroenterology and Hepatology, Clinique Sainte Barbe, Strasbourg, France
,
Carina Leal
2   Hepatogastroenterology Department, Cliniques universitaires St-Luc, Université catholique de Louvain, Brussels, Belgium
,
Jérémie Albouys
9   Hepato-Gastroenterology Department, Dupuytren University Hospital, Limoges, France
,
Jean-Baptiste Chevaux
1   Department of Gastroenterology, Nancy Regional University Hospital Center, Nancy, France
,
Maximilien Barret
19   Department of Gastroenterology, Cochin Hospital, Paris, France
,
1   Department of Gastroenterology, Nancy Regional University Hospital Center, Nancy, France
› Author Affiliations


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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.



Publication History

Received: 03 April 2022

Accepted after revision: 03 May 2023

Accepted Manuscript online:
03 May 2023

Article published online:
13 July 2023

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