title: Endoscopic Submucosal Dissection of Superficial Esophageal Neoplasms Is Feasible and Not Riskier for Patients with Liver Cirrhosis.
abstract: Esophageal endoscopic submucosal dissection (ESD) has rarely been reported for the treatment of cirrhotic patients.
  
  
  
  To report the results of ESD treatment of superficial esophageal neoplasms (SENs) for cirrhotic patients.
  
  
  
  Forty patients with 50 consecutive SENs undergoing 46 sessions of ESD were retrospectively reviewed. The cirrhotic group included eight patients (11 SENs) with liver cirrhosis consisting of six patients classified as Child-Pugh class A liver cirrhosis and two patients classified as class B liver cirrhosis. Four patients (6 SENs) had coexisting esophageal varices. Parameters were compared between the cirrhotic patients and the non-cirrhotic controls (32 patients, 39 SENs).
  
  
  
  Platelet counts of the cirrhotic group were significantly lower, while international normalized ratio was significantly higher. When the cirrhotic group and non-cirrhotic group were compared, the mean tumor length (4 vs. 3.7 cm, p = 0.56) and median procedure time (15.1 vs. 11.5 min/cm2, p = 0.30) were similar. The en bloc resection rates were 81.8 and 89.7 % (p = 0.60). Within the cirrhotic group, both lesions without en bloc resection were patients with esophageal varices. The rates of submucosal disease for the cirrhotic group and non-cirrhotic groups were 54.5 and 25.6 % (p = 0.064), respectively, while the R0 resection rates were 77.8 and 94.3 % (p = 0.16), respectively. The two lesions without R0 resection in cirrhotic group had positive vertical but not horizontal margins due to submucosal invasion. Intraprocedural bleeding occurred more frequently in cirrhotic patients than non-cirrhotic patients (18.2 vs. 0 %, p = 0.045). None of the patients suffered from esophageal perforation, postoperative bleeding, or death that was related to the ESD.
  
  
  
  Esophageal ESD seems to be safely and can be effectively performed on cirrhotic patients, particularly those without severe liver dysfunction.
authors: Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors: Yung-Kuan
authors: YK
authors: Tsou
authors: Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital and Department of Medicine, Mackay Medical College, New Taipei, Taiwan.
authors: Chia-Yuan
authors: CY
authors: Liu
authors: Department of Gastroenterology, Kanma Memorial Hospital, Nasushiobara, Japan.
authors: Kuang-I
authors: KI
authors: Fu
authors: Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors: Cheng-Hui
authors: CH
authors: Lin
authors: Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors: Mu-Shien
authors: MS
authors: Lee
authors: Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors: Ming-Yao
authors: MY
authors: Su
authors: Department of Gastroenterology, NTT Medical Center Tokyo, 5-9-22 Higashi-gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan. ken.ohata1974@gmail.com.
authors: Ken
authors: K
authors: Ohata
authors: Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors: Cheng-Tang
authors: CT
authors: Chiu
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016022:Case-Control Studies; D000069916:Endoscopic Mucosal Resection / Q000379:methods*; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D004939:Esophageal Perforation / Q000453:epidemiology; D000077277:Esophageal Squamous Cell Carcinoma; D004932:Esophageal and Gastric Varices / Q000209:etiology; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009873:Operating Rooms; D010976:Platelet Count; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D047368:Tumor Burden
keywords: Endoscopic submucosal dissection; Esophageal varices; Esophagus; Liver cirrhosis; Superficial esophageal neoplasm