title: Endoscopic submucosal dissection of gastric neoplastic lesions in patients with liver cirrhosis: a systematic review.
abstract: OBJECTIVE
  Endoscopic submucosal dissection  (ESD) is effective and safe for the removal of neoplastic lesions in the general population, but its role in patients with cirrhosis is not clear. We evaluated data on feasibility and safety of ESD for gastric lesions in cirrhotic patients.
  
  
  METHODS
  A systematic review of the literature with pooled-data analysis was performed. Data of all consecutive cirrhotics who underwent ESD for gastric neoplastic lesions in a single centre were also reported.
  
  
  RESULTS
  In reviewing the published literature, 68 ESD procedures for gastric neoplastic lesions have been performed in 61 cirrhotics, including 5 patients from our experience. En bloc removal and the R0 resection were successful in 88.2% and 89.7% of procedures, respectively. Post-ESD bleeding occurred in 8 (13.1%) patients, and perforation in 1 (1.6%). All patients were successfully managed by endoscopic treatment. No procedure-related death was observed. Patients with advanced cirrhosis, with either INR >1.33 and/or platelets count <105,000/cmm should be regarded at increased risk of bleeding following ESD.
  
  
  CONCLUSIONS
  ESD for gastric neoplastic lesions in cirrhotics is an effective and relatively safe procedure. Procedure-related bleeding is a frequent complication, but can be successfully managed endoscopically.
authors.affiliation: Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Milan, Italy. alessandro.repici@humanitas.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Repici
authors.forename: Nico
authors.initials: N
authors.lastname: Pagano
authors.forename: Cesare
authors.initials: C
authors.lastname: Hassan
authors.forename: Sergio
authors.initials: S
authors.lastname: Cavenati
authors.forename: Giacomo
authors.initials: G
authors.lastname: Rando
authors.forename: Paola
authors.initials: P
authors.lastname: Spaggiari
authors.forename: Prateek
authors.initials: P
authors.lastname: Sharma
authors.forename: Angelo
authors.initials: A
authors.lastname: Zullo
mesh_terms: D004210:Dissection; D016099:Endoscopy, Gastrointestinal; D005753:Gastric Mucosa / Q000601:surgery; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D013274:Stomach Neoplasms / Q000150:complications / Q000601:surgery*