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Digestive Diseases and Sciences
Published in: Digestive Diseases and Sciences 10/2022

06-01-2022 | Liver Cirrhosis | Original Article

Advanced Endoscopic Resection Techniques in Cirrhosis—A Systematic Review and Meta-Analysis of Outcomes

Authors: Saurabh Chandan, Smit Deliwala, Shahab R. Khan, Daryl Ramai, Babu P. Mohan, Mohammad Bilal, Antonio Facciorusso, Lena L. Kassab, Faisal Kamal, Banreet Dhindsa, Abhilash Perisetti, Douglas G. Adler

Published in: Digestive Diseases and Sciences | Issue 10/2022

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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.
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Metadata
Title
Advanced Endoscopic Resection Techniques in Cirrhosis—A Systematic Review and Meta-Analysis of Outcomes
Authors
Saurabh Chandan
Smit Deliwala
Shahab R. Khan
Daryl Ramai
Babu P. Mohan
Mohammad Bilal
Antonio Facciorusso
Lena L. Kassab
Faisal Kamal
Banreet Dhindsa
Abhilash Perisetti
Douglas G. Adler
Publication date
06-01-2022
Publisher
Springer US
Keyword
Liver Cirrhosis
Published in
Digestive Diseases and Sciences / Issue 10/2022
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-021-07364-w

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