925 EFFICACY AND SAFETY OF ENDOSCOPIC SUBMUCOSAL DISSECTION FOR GASTRIC NEOPLASMS IN PATIENTS WITH COMPENSATED LIVER CIRRHOSIS: A PROPENSITY SCORE-MATCHED CASE-CONTROL STUDY

Abstract

The clinical outcomes of endoscopic submucosal dissection (ESD) for gastric neoplasms in liver cirrhosis patients are not adequately reported; hence, clinicians perform this procedure with vague fears regarding adverse events, including bleeding and worsening of liver function. We compared the efficacy and safety of ESD between cirrhosis and non-cirrhosis patients. From January 2005 to December 2014, 158 cirrhosis patients underwent ESD for gastric neoplasms at a tertiary medical institution. To compare the clinical outcomes, a propensity score-matched control group (158 patients) was selected from non-cirrhosis patients, using age, sex, histology, tumor location, and lesion size as variables. 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 significantly differ from those in the non-cirrhosis group. Median procedure time (25.0 vs. 23.0 min) was also comparable between the groups. In the survival analysis, cirrhosis patients exhibited a significantly higher mortality risk than non-cirrhosis patients [hazard ratio (HR), 3.52; 95% confidence interval (CI), 1.35–9.23, p = 0.01], and those without HCC exhibited a mortality risk similar to the non-cirrhosis group (HR, 2.14; 95% CI, 0.72–6.39; p = 0.171). Three among 153 patients (2%) exhibited worsening of prognosis from Child–Pugh class A to B. ESD for gastric epithelial neoplasms can be performed in compensated cirrhosis patients, especially in those without HCC, with comparable safety and efficacy and without worsening of liver function.Tabled 1Outcomes of endoscopic submucosal dissection in the cirrhosis and non-cirrhosis groups after propensity score-matchingCirrhosis (n = 158)Non-cirrhosis (n = 158)p valueSize of the specimen, mm41.0 (35.0-50.0)44.5 (35.0-54.0)0.143Procedure time, minutes25.0 (16.0-31.2)23.0 (15.3-32.0)0.808En bloc resection153 (96.8)153 (96.8)1.000Curative resection142 (89.9)144 (91.1)0.838Bleeding16 (10.1)12 (7.6)0.571Perforation3 (1.9)0 (0)0.248Hospital duration, days3.0 (3.0-5.0)3.0 (3.0-4.0)<0.001Overall mortality17 (10.8)5 (3.2)0.01Procedure-related mortality0 (0)0 (0)1.000The data represent the number of patients (%) or the median (interquartile range) Open table in a new tab