Endoscopic Submucosal Dissection of Gastric Neoplastic Lesions in Patients with Liver Cirrhosis: a Systematic Review

Background & Aims: Endoscopic submucosal dissection (ESD) is effective and safe for the removal of neoplastic lesions in the general population, but its role in patients with cirrhosis is not clear. We evaluated data on feasibility and safety of ESD for gastric lesions in cirrhotic patients. Methods: A systematic review of the literature with pooled-data analysis was performed. Data of all consecutive cirrhotics who underwent ESD for gastric neoplastic lesions in a single centre were also reported. Results: In reviewing the published literature, 68 ESD procedures for gastric neoplastic lesions have been performed in 61 cirrhotics, including 5 patients from our experience. En bloc removal and the R0 resection were successful in 88.2% and 89.7% of procedures, respectively. Post-ESD bleeding occurred in 8 (13.1%) patients, and perforation in 1 (1.6%). All patients were successfully managed by endoscopic treatment. No procedure-related death was observed. Patients with advanced cirrhosis, with either INR >1.33 and/or platelets count <105,000/mm(3) should be regarded at increased risk of bleeding following ESD. Conclusions: ESD for gastric neoplastic lesions in cirrhotics is an effective and relatively safe procedure. Procedure-related bleeding is a frequent complication, but can be successfully managed endoscopically.