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Endoscopy 2024; 56(02): 119-124
DOI: 10.1055/a-2159-2557
Innovations and brief communications

Clinical outcomes of endoscopic submucosal dissection for superficial esophageal neoplasia in close proximity to esophageal varices: a multicenter international experience

Shruti Mony‡   ‡
1   Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
2   Division of Gastroenterology and Hepatology , University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
,
Bing Hu  ‡   ‡
3   Department of Gastroenterology, West China Longquan Hospital, Sichuan University, Sichuan Province, China
,
Abel Joseph 
4   Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, Ohio, USA
,
Hiroyuki Aihara
5   Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
,
Lorenzo Ferri
6   Department of Surgery, Division of Thoracic Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
,
Amit Bhatt 
4   Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, Ohio, USA
,
Amit Mehta
1   Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
,
Peng-Sheng Ting
1   Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
,
Alex Chen
6   Department of Surgery, Division of Thoracic Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
,
Andrew Kalra 
1   Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
,
Jad Farha 
1   Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
,
Manabu Onimaru
7   Digestive Diseases Center, Showa University, Koto-Toyosu Hospital, Tokyo, Japan
,
Long He
8   Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
,
Qi Luo
3   Department of Gastroenterology, West China Longquan Hospital, Sichuan University, Sichuan Province, China
,
Andrew Y. Wang
9   Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, USA
,
Haruhiro Inoue
7   Digestive Diseases Center, Showa University, Koto-Toyosu Hospital, Tokyo, Japan
,
Saowanee Ngamruengphong
1   Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Abstract

Background There are limited data on the feasibility of endoscopic submucosal dissection (ESD) for superficial esophageal neoplasia (SEN) located at or adjacent to esophageal varices. We aimed to evaluate the outcomes of ESD in these patients.

Methods This multicenter retrospective study included cirrhotic patients with a history of esophageal varices with SEN located at or adjacent to the esophageal varices who underwent ESD.

Results 23 patients with SEN (median lesion size 30 mm; 16 squamous cell neoplasia and seven Barrett’s esophagus-related neoplasia) were included. The majority were Child–Pugh B (57 %) and had small esophageal varices (87 %). En bloc, R0, and curative resections were achieved in 22 (96 %), 21 (91 %), and 19 (83 %) of patients, respectively. Severe intraprocedural bleeding (n = 1) and delayed bleeding (n = 1) were successfully treated endoscopically. No delayed perforation, hepatic decompensation, or deaths were observed. During a median (interquartile range) follow-up of 36 (22–55) months, one case of local recurrence occurred after noncurative resection.

Conclusion ESD is feasible and effective for SEN located at or adjacent to esophageal varices in cirrhotic patients. Albeit, the majority of the esophageal varices in our study were small in size, when expertise is available, ESD should be considered as a viable option for such patients.

‡ Joint first authors


Supplementary material



Publication History

Received: 30 October 2022

Accepted after revision: 23 August 2023

Accepted Manuscript online:
23 August 2023

Article published online:
04 December 2023

© 2023. Thieme. All rights reserved.

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