Case Control Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. May 27, 2024; 16(5): 784-790
Published online May 27, 2024. doi: 10.4254/wjh.v16.i5.784
Outcomes of endoscopic submucosal dissection in cirrhotic patients: First American cohort
Robert Luke Pecha, Fares Ayoub, Ankur Patel, Abdullah Muftah, Michael W Wright, Mai A Khalaf, Mohamed O Othman
Robert Luke Pecha, Department of Gastroenterology and Hepatology, UC Davis, Sacramento, CA 95817, United States
Fares Ayoub, Mohamed O Othman, Department of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX 77030, United States
Ankur Patel, Internal Medicine, Baylor College of Medicine, Houston, TX 77030, United States
Abdullah Muftah, Department of Gastroenterology and Hepatology, University of Texas Medical Branch at Galveston, Galveston, TX 77550, United States
Michael W Wright, Medical School, Baylor College of Medicine, Houston, TX 77030, United States
Mai A Khalaf, Department of Tropical Medicine, Tanta University, Tanta 31527, Egypt
Author contributions: Pecha RL, Ayoub F performed study conceptualization, data collection, statistical analysis, drafted and revised the manuscript; Khalaf MA performed study conceptualization, data collection; Patel A, Muftah A, Wright MW performed data collection; Othman MO performed study conceptualization, drafted and revised the manuscript.
Institutional review board statement: This study was reviewed and approved by the Baylor College of Medicine Institutional Review Board.
Informed consent statement: A Waiver of informed consent and HIPAA was provided by the Baylor College of Medicine institutional review board. This research involves no more than a minimal risk to the subjects.
Conflict-of-interest statement: Robert Luke Pecha, Fares Ayoub, Ankur Patel, Abdullah Muftah, Michael Wright, Mai Khalaf: No conflicts of interest to disclose. Mohamed O. Othman: Mohamed O Othman is a consultant for Olympus, Boston Scientific Corporation, Abbvie, ConMed, Lumendi and Apollo. Mohamed O Othman received research grants from Lucid Diagnostics, AbbVie and ConMed.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at rlpecha@ucdavis.edu. Consent was not obtained but the presented data are anonymized and risk of identification is low.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement- checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Robert Luke Pecha, MD, Academic Fellow, Department of Gastroenterology and Hepatology, UC Davis, Sacramento, CA 95817, United States. rlpecha@ucdavis.edu
Received: December 22, 2023
Revised: January 29, 2024
Accepted: April 16, 2024
Published online: May 27, 2024
Processing time: 151 Days and 16.1 Hours
Abstract
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.

Keywords: Endoscopic aubmucosal dissection, Cirrhosis, Advanced polypectomy, Intraprocedural bleeding, Colon cancer

Core Tip: In our 1:2 matched case control study comparing patients with and without cirrhosis undergoing endoscopic submucosal dissection, we found that cirrhotic patients required higher rates of intraprocedural coagulation graspers use, and had higher rates of lesion recurrence among those with follow-up endoscopy.