ENDOSCOPIC RESECTIONS IN CIRRHOTIC PATIENTS: OUTCOMES AND ADVERSE EVENTS OF 269 PROCEDURES

Aims:

Endoscopic resection (ER) is a safe method for treatment of superficial digestive neoplasia. However, results in cirrhotic patients have not been fully evaluated. On the contrary, abdominal surgery is at high risk of hepatic decompensations, infections and bleedings. ER could be an interesting alternative.

Our study aimed to evaluate effectiveness, risk factors and safety of ER in cirrhotic patients.

Methods:

We designed a retrospective study. Patients diagnosed cirrhotic, admitted in our unit for an ER between 2009 and 2016, were included.

Results:

78 ER were in the upper gastro-intestinal (GI) tract, in 51 patients. They had mild liver cirrhosis (mean MELD score: 8.9). During the 30 days post ER, no patient died (4 died during follow up, average time of death after ER: 34.6 months). The morbidity was 5.1%: one isolated fever, and 3 bleedings. The duodenal location of ER was a significant risk factor of bleeding (p = 0.009). Cirrhosis decompensation did not occur.

191 ER were in the lower GI tract, in 83 patients. They had mild liver cirrhosis (mean MELD score: 10.4). During the 30 days post ER, no patient died (follow-up: 19 patients died, mean time of death after ER: 25.7 months). The morbidity was 2.6% (5 bleedings). There were no other complications. In univariate analysis, risk factors of bleeding were MELD score and anti-platelets therapy (p = 0.041 and 0.004) and only anti-platelets therapy in multivariate analysis (p < 0.05).

The curative rates in the upper and lower GI tract were 70.5% and 86.9%.

Conclusions:

Liver cirrhosis had a limited impact on the outcomes of ER, and ER did not induce cirrhosis decompensation. Bleeding was the most frequent adverse event (after duodenal ER or under anti-platelets therapy). Patients who bled had a compensated, or mildly decompensated cirrhosis.

ER are safe and effective in cirrhotic patients and should be proposed as a first possibility.