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

Shruti Mony; Bing Hu; Abel Joseph; Hiroyuki Aihara; Lorenzo Ferri; Amit Bhatt; Amit Mehta; Peng-Sheng Ting; Alex Chen; Andrew Kalra; Jad Farha; Manabu Onimaru; Long He; Qi Luo; Andrew Y. Wang; Haruhiro Inoue; Saowanee Ngamruengphong

doi:10.1055/a-2159-2557

Endoscopy, Table of Contents

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‡^‡

¹Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA

²Division of Gastroenterology and Hepatology , University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA

,

Bing Hu ‡^‡

³Department of Gastroenterology, West China Longquan Hospital, Sichuan University, Sichuan Province, China

,

Abel Joseph

⁴Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, Ohio, USA

,

Hiroyuki Aihara

⁵Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA

,

Lorenzo Ferri

⁶Department of Surgery, Division of Thoracic Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada

,

Amit Bhatt

⁴Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, Ohio, USA

,

Amit Mehta

¹Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA

,

Peng-Sheng Ting

¹Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA

,

Alex Chen

⁶Department of Surgery, Division of Thoracic Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada

,

Andrew Kalra

¹Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA

,

Jad Farha

¹Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA

,

Manabu Onimaru

⁷Digestive Diseases Center, Showa University, Koto-Toyosu Hospital, Tokyo, Japan

,

Long He

⁸Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

,

Qi Luo

³Department of Gastroenterology, West China Longquan Hospital, Sichuan University, Sichuan Province, China

,

Andrew Y. Wang

⁹Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, USA

,

Haruhiro Inoue

⁷Digestive Diseases Center, Showa University, Koto-Toyosu Hospital, Tokyo, Japan

,

Saowanee Ngamruengphong

¹Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA

› Author Affiliations

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.

Full Text

References

References
1 Terheggen G, Horn EM, Vieth M. et al. A randomised trial of endoscopic submucosal dissection versus endoscopic mucosal resection for early Barrett's neoplasia. Gut 2017; 66: 783-793
2 Yang D, Zou F, Xiong S. et al. Endoscopic submucosal dissection for early Barrett's neoplasia: a meta-analysis. Gastrointest Endosc 2018; 87: 1383-1393
3 Guo HM, Zhang XQ, Chen M. et al. Endoscopic submucosal dissection vs endoscopic mucosal res ection for superficial esophageal cancer. World J Gastroenterol 2014; 20: 5540-5547
4 Draganov PV, Aihara H, Karasik MS. et al. Endoscopic submucosal dissection in North America: a large prospective multicenter study. Gastroenterology 2021; 160: 2317-2327.e2
5 Zaman A, Hapke R, Flora K. et al. Prevalence of upper and lower gastrointestinal tract findings in liver transplant candidates undergoing screening endoscopic evaluation. Am J Gastroenterol 1999; 94: 895-899
6 Tachibana M, Kotoh T, Kinugasa S. et al. Esophageal cancer with cirrhosis of the liver: results of esophagectomy in 18 consecutive patients. Ann Surg Oncol 2000; 7: 758-763
7 Schizas D, Giannopoulos S, Vailas M. et al. The impact of cirrhosis on esophageal cancer surgery: An up-to-date meta-analysis. Am J Surg 2020; 220: 865-872
8 Tsou YK, Liu CY, Fu KI. et al. Endoscopic submucosal dissection of superficial esophageal neoplasms is feasible and not riskier for patients with liver cirrhosis. Dig Dis Sci 2016; 61: 3565-3571
9 Ueda C, Yosizaki T, Katayama N. et al. Barrett's adenocarcinoma with esophageal varices successfully treated by endoscopic submucosal dissection with direct varices coagulation. Clin J Gastroenterol 2020; 13: 178-181
10 Sawaguchi M, Jin M, Matsuhashi T. et al. The feasibility of endoscopic submucosal dissection for superficial esophageal cancer in patients with cirrhosis [with video]. Gastrointest Endosc 2014; 79: 681-685
11 Yang D, Coman RM, Kahaleh M. et al. Endoscopic submucosal dissection for Barrett's early neoplasia: a multicenter study in the United States. Gastrointest Endosc 2017; 86: 600-607
12 Qumseya B, Sultan S, Bain P. et al. ASGE guideline on screening and surveillance of Barrett's esophagus. Gastrointest Endosc 2019; 90: 335-359.e2
13 Shaheen NJ, Falk GW, Iyer PG. et al. ACG Clinical Guideline: diagnosis and management of Barrett's esophagus. Am J Gastroenterol 2016; 111: 30-50 ; quiz 51
14 Choi YK, Noh JH, Kim DH. et al. Outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms in patients with liver cirrhosis. Clin Endosc 2022; 55: 381-389
15 Xu ZG, Zhao YB, Yu J. et al. Novel endoscopic treatment strategy for early esophageal cancer in cirrhotic patients with esophageal varices. Oncol Lett 2019; 18: 2560-2567
16 Liu YZ, Lv XH, Deng K. et al. Efficacy and safety of endoscopic submucosal tunnel dissection vs endoscopic submucosal dissection for early superficial upper gastrointestinal precancerous lesions and tumors: A meta-analysis. J Dig Dis 2020; 21: 480-489
17 Draganov PV, Wang AY, Othman MO. et al. AGA Institute Clinical Practice Update: endoscopic submucosal dissection in the United States. Clin Gastroenterol Hepatol 2019; 17: 16-25.e1
18 Kataoka Y, Tsuji Y, Sakaguchi Y. et al. Bleeding after endoscopic submucosal dissection: Risk factors and preventive methods. World J Gastroenterol 2016; 22: 5927-5935
19 Pimentel-Nunes P, Libânio D, Bastiaansen BAJ. et al. Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy [ESGE] Guideline – Update 2022. Endoscopy 2022; 54: 591-622

Supplementary Material

Supplementary material