Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Milan, Italy.
J Gastrointestin Liver Dis. 2012 Sep;21(3):303-7.
BACKGROUND & AIMS: 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.
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.
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.
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.
内镜黏膜下剥离术（ESD）对于治疗一般人群中的肿瘤性病变是有效且安全的，但在肝硬化患者中的作用尚不清楚。我们评估了 ESD 治疗肝硬化患者胃病变的可行性和安全性数据。
进行了文献系统评价和汇总数据分析。还报告了单中心对胃肿瘤性病变行 ESD 的所有连续肝硬化患者的数据。
在对已发表文献进行综述时，在 61 例肝硬化患者中进行了 68 例胃肿瘤性病变的 ESD，其中包括我们经验中的 5 例患者。整块切除和 R0 切除的成功率分别为 88.2%和 89.7%。8 例（13.1%）患者发生 ESD 后出血，1 例（1.6%）发生穿孔。所有患者均通过内镜治疗成功处理。未观察到与操作相关的死亡。INR>1.33 和/或血小板计数<105,000/cmm 的晚期肝硬化患者，在接受 ESD 后应视为出血风险增加。
ESD 治疗肝硬化患者的胃肿瘤性病变是一种有效且相对安全的方法。与操作相关的出血是一种常见的并发症，但可以通过内镜成功治疗。
