Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Gastrointest Endosc. 2018 Jun;87(6):1423-1431.e3. doi: 10.1016/j.gie.2018.01.035. Epub 2018 Mar 28.
The clinical outcomes of endoscopic submucosal dissection (ESD) for gastric neoplasms in liver cirrhosis patients have not been adequately reported, leading to clinician concerns about adverse events, including bleeding and the deterioration of liver function. We compared the efficacy and safety of ESD between cirrhosis and noncirrhosis patients.
Between January 2005 and December 2014, 158 cirrhosis patients underwent ESD for gastric neoplasms at a tertiary medical institution. Their clinical outcomes were compared with those of a propensity score-matched control group (158 patients) selected from noncirrhosis patients, using age, sex, histology, tumor location, and lesion size as variables.
En bloc resection (96.8%), curative resection (89.9%), and adverse event (bleeding [10.1%] and perforation [1.9%]) rates in the cirrhosis group did not differ significantly from those in the noncirrhosis group. The median procedure time (25.0 vs 23.0 minutes) was also comparable between the groups. In a survival analysis cirrhosis patients exhibited a significantly higher mortality risk than noncirrhosis patients (hazard ratio [HR], 3.52; 95% confidence interval [CI], 1.35-9.23; P = .01). Cirrhosis patients without hepatocellular carcinoma (HCC) showed no statistically significant difference in mortality compared with the noncirrhosis group (HR, 2.14; 95% CI, .72-6.39; P = .171). Three of 153 patients (2%) exhibited a deterioration of prognosis from Child-Pugh class A to B.
In compensated cirrhosis patients, especially those without HCC, ESD for gastric epithelial neoplasms can be performed with safety and efficacy comparable with that in noncirrhosis patients, without deterioration in liver function.
肝硬化患者行内镜黏膜下剥离术（ESD）治疗胃肿瘤的临床结局尚未得到充分报道，这导致临床医生对包括出血和肝功能恶化在内的不良事件感到担忧。我们比较了肝硬化和非肝硬化患者行 ESD 的疗效和安全性。
在一家三级医疗机构，我们对 2005 年 1 月至 2014 年 12 月期间 158 例肝硬化患者行 ESD 治疗胃肿瘤，并将其临床结局与 158 例非肝硬化患者（通过年龄、性别、组织学、肿瘤位置和病变大小等变量进行倾向评分匹配）的临床结局进行比较。
肝硬化组的整块切除率（96.8%）、治愈性切除率（89.9%）和不良事件（出血[10.1%]和穿孔[1.9%]）发生率与非肝硬化组无显著差异。两组的中位手术时间（25.0 分钟比 23.0 分钟）也相似。在生存分析中，肝硬化患者的死亡率显著高于非肝硬化患者（风险比[HR]，3.52；95%置信区间[CI]，1.35-9.23；P =.01）。无肝细胞癌（HCC）的肝硬化患者与非肝硬化患者的死亡率无统计学差异（HR，2.14；95% CI，.72-6.39；P =.171）。153 例患者中有 3 例（2%）的预后从 Child-Pugh 分级 A 恶化至 B 级。
在代偿期肝硬化患者中，尤其是无 HCC 的患者中，行 ESD 治疗胃上皮性肿瘤可安全有效地进行，且不会导致肝功能恶化。
