失代偿期肝硬化患者常见内镜治疗的安全性和有效性

Safety and efficacy of common endoscopic treatments in patients with decompensated liver cirrhosis.

作者信息

Yang Hang, Mou Yi, Hu Bing

机构信息

Department of Gastroenterology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Wu Hou District, Chengdu 610041, China.

出版信息

Ann Hepatol. 2022 May-Jun;27(3):100689. doi: 10.1016/j.aohep.2022.100689. Epub 2022 Feb 19.

DOI:10.1016/j.aohep.2022.100689

PMID:35192965

Abstract

INTRODUCTION

The safety and efficacy have always been a concern, when patients with decompensated liver cirrhosis (DLC) receive endoscopic treatments.

METHODS

To evaluate the safety and efficacy of common endoscopic treatments including endoscopic resection (ER) and endoscopic retrograde cholangiopancreatography (ERCP) applying to patients with DLC, we performed a retrospective study finally including 81 patients receiving ER (43 endoscopic mucosal resection (EMR) and 38 endoscopic submucosal dissection (ESD)) and 131 patients treated by ERCP.

RESULTS

There were no significant differences in the rate of degeneration and invariability of Child-Pugh (CP) class and the overall rate of adverse events between two groups (93.8%/8.6% ER vs. 96.2%/15.3% ERCP). Both the degeneration rate of CP class (35.4%) and the rate of adverse events (27.1%) in subgroup CP class C of ERCP group were significantly higher (P=0). The rate of poor outcomes was higher in ERCP group (12.2%) than that in ER group (2.5%) (P=0.02). And subgroup CP class C of ERCP group had a higher poor outcome rate (27.1%) (P=0).

CONCLUSION

ER and ERCP could remove focal lesions or relieve symptoms induced by targeted diseases without significant changes of CP class. Significant benefits and risks coexisted in CP class C patients with DLC when receiving ERCP.

摘要

引言

失代偿期肝硬化（DLC）患者接受内镜治疗时，其安全性和有效性一直是人们关注的问题。

方法

为评估包括内镜切除术（ER）和内镜逆行胰胆管造影术（ERCP）在内的常见内镜治疗应用于DLC患者的安全性和有效性，我们进行了一项回顾性研究，最终纳入81例行ER治疗的患者（43例行内镜黏膜切除术（EMR）和38例行内镜黏膜下剥离术（ESD））以及131例行ERCP治疗的患者。

结果

两组之间Child-Pugh（CP）分级退变和不变率以及不良事件总发生率无显著差异（ER组为93.8%/8.6%，ERCP组为96.2%/15.3%）。ERCP组CP分级C亚组的CP分级退变率（35.4%）和不良事件发生率（27.1%）均显著更高（P = 0）。ERCP组的不良结局发生率（12.2%）高于ER组（2.5%）（P = 0.02）。并且ERCP组的CP分级C亚组不良结局发生率更高（27.1%）（P = 0）。