Saurabh Chandan1, Smit Deliwala2, Shahab R Khan3, Daryl Ramai4, Babu P Mohan4, Mohammad Bilal5, Antonio Facciorusso6, Lena L Kassab7, Faisal Kamal8, Banreet Dhindsa9, Abhilash Perisetti10, Douglas G Adler11,12. 1. Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, NE, USA. 2. Internal Medicine, Hurley Medical Center, Flint, MI, USA. 3. Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 4. Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA. 5. Division of Gastroenterology, University of Minnesota & Minneapolis VA Health Care System, Minneapolis, MN, USA. 6. Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy. 7. Internal Medicine, Mayo Clinic, Rochester, MN, USA. 8. Division of Gastroenterology, University of California-San Francisco, San Francisco, CA, USA. 9. Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE, USA. 10. Division of Gastroenterology, Parkview Health, Fort Wayne, IN, USA. 11. Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA. Douglasadler@centura.org. 12. Center for Advanced Therapeutic Endoscopy (CATE), Centura Health, Porter Adventist Hospital, Denver, CO, USA. Douglasadler@centura.org.
Abstract
BACKGROUND/AIMS: While safety and effectiveness of advanced endoscopic resection techniques such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) has been well established in general population, data regarding their utility in patients with cirrhosis is limited. METHODS: We searched multiple databases from inception through July 2021 to identify studies that reported on outcomes of EMR and/or ESD in patients with cirrhosis. Meta-analysis was performed to determine pooled rates of immediate and delayed bleeding, perforation, death as well as rates of successful en bloc and R0 resection. Pooled relative risk (RR) was calculated for each outcome between patients with and without cirrhosis. RESULTS: Ten studies with a total of 3244 patients were included in the final analysis. Pooled rates of immediate & delayed bleeding, perforation, and death during EMR and/or ESD in patients with cirrhosis were 9.5% (CI 4.0-21.1), 6.6% (CI 4.2-10.3), 2.1% (CI 1.1-3.9) and 0.6% (CI 0.2-1.7), respectively. Pooled rates of successful en bloc and R0 resection were 93% (CI 85.9-96.7) and 90.8% (CI 86.5-93.8), respectively. While incidence of immediate bleeding was higher in patients with cirrhosis, there was no statistically significant difference in any of the other outcomes between the patient groups. CONCLUSIONS: Our study shows that performing EMR and ESD for gastrointestinal lesions in patients with cirrhosis is both safe and effective. The risks of procedural complications parallel those reported in general population.
BACKGROUND/AIMS: While safety and effectiveness of advanced endoscopic resection techniques such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) has been well established in general population, data regarding their utility in patients with cirrhosis is limited. METHODS: We searched multiple databases from inception through July 2021 to identify studies that reported on outcomes of EMR and/or ESD in patients with cirrhosis. Meta-analysis was performed to determine pooled rates of immediate and delayed bleeding, perforation, death as well as rates of successful en bloc and R0 resection. Pooled relative risk (RR) was calculated for each outcome between patients with and without cirrhosis. RESULTS: Ten studies with a total of 3244 patients were included in the final analysis. Pooled rates of immediate & delayed bleeding, perforation, and death during EMR and/or ESD in patients with cirrhosis were 9.5% (CI 4.0-21.1), 6.6% (CI 4.2-10.3), 2.1% (CI 1.1-3.9) and 0.6% (CI 0.2-1.7), respectively. Pooled rates of successful en bloc and R0 resection were 93% (CI 85.9-96.7) and 90.8% (CI 86.5-93.8), respectively. While incidence of immediate bleeding was higher in patients with cirrhosis, there was no statistically significant difference in any of the other outcomes between the patient groups. CONCLUSIONS: Our study shows that performing EMR and ESD for gastrointestinal lesions in patients with cirrhosis is both safe and effective. The risks of procedural complications parallel those reported in general population.
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