Background and Aims

The clinical outcomes of endoscopic submucosal dissection (ESD) for gastric neoplasms in liver cirrhosis patients have not been adequately reported, leading to clinician concerns about adverse events, including bleeding and the deterioration of liver function. We compared the efficacy and safety of ESD between cirrhosis and noncirrhosis patients.

Methods

Between January 2005 and December 2014, 158 cirrhosis patients underwent ESD for gastric neoplasms at a tertiary medical institution. Their clinical outcomes were compared with those of a propensity score–matched control group (158 patients) selected from noncirrhosis patients, using age, sex, histology, tumor location, and lesion size as variables.

Results

En bloc resection (96.8%), curative resection (89.9%), and adverse event (bleeding [10.1%] and perforation [1.9%]) rates in the cirrhosis group did not differ significantly from those in the noncirrhosis group. The median procedure time (25.0 vs 23.0 minutes) was also comparable between the groups. In a survival analysis cirrhosis patients exhibited a significantly higher mortality risk than noncirrhosis patients (hazard ratio [HR], 3.52; 95% confidence interval [CI], 1.35-9.23; P = .01). Cirrhosis patients without hepatocellular carcinoma (HCC) showed no statistically significant difference in mortality compared with the noncirrhosis group (HR, 2.14; 95% CI, .72-6.39; P = .171). Three of 153 patients (2%) exhibited a deterioration of prognosis from Child-Pugh class A to B.

Conclusions

In compensated cirrhosis patients, especially those without HCC, ESD for gastric epithelial neoplasms can be performed with safety and efficacy comparable with that in noncirrhosis patients, without deterioration in liver function.

中文翻译：

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内镜黏膜下剥离术对代偿性肝硬化患者胃肿瘤的疗效和安全性：倾向评分与病例对照研究

背景和目标

肝硬化患者胃肿瘤的内镜黏膜下剥离术（ESD）的临床结局尚未得到充分报道，导致临床医生担心包括出血和肝功能恶化在内的不良事件。我们比较了肝硬化和非肝硬化患者的ESD疗效和安全性。

方法

在2005年1月至2014年12月期间，在一家三级医疗机构中对158例肝硬化患者进行了胃肿瘤的ESD治疗。使用年龄，性别，组织学，肿瘤位置和病变大小作为变量，将他们的临床结局与从非肝硬化患者中选择的倾向得分匹配的对照组（158例）进行比较。

结果

肝硬化组的整体切除率（96.8％），根治性切除术（89.9％）和不良事件（出血[10.1％]和穿孔[1.9％]）的发生率与非肝硬化组无显着差异。两组之间的中位手术时间（25.0 vs 23.0分钟）也相当。在生存分析中，肝硬化患者的死亡风险显着高于非肝硬化患者（危险比[HR]为3.52； 95％置信区间[CI]为1.35-9.23；P  = 0.01）。与非肝硬化组相比，无肝细胞癌（HCC）的肝硬化患者的死亡率无统计学差异（HR，2.14； 95％CI，.72-6.39；P  = .171）。153例患者中有3例（2％）表现出从Child-Pugh A级到B级的预后恶化。

结论

在代偿性肝硬化患者中，特别是没有肝癌的患者，可以执行与非肝硬化患者相当的安全性和有效性的胃上皮肿瘤ESD治疗，而不会肝功能恶化。