TY - JOUR
T1 - Advanced Endoscopic Resection Techniques in Cirrhosis—A Systematic Review and Meta-Analysis of Outcomes
AU - Chandan, Saurabh
AU - Deliwala, Smit
AU - Khan, Shahab R.
AU - Ramai, Daryl
AU - Mohan, Babu P.
AU - Bilal, Mohammad
AU - Facciorusso, Antonio
AU - Kassab, Lena L.
AU - Kamal, Faisal
AU - Dhindsa, Banreet
AU - Perisetti, Abhilash
AU - Adler, Douglas G.
N1 - Funding Information:
Dana Gerberi, MLIS, Librarian, Mayo Clinic Libraries, for help with the systematic literature search.
Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2022/10
Y1 - 2022/10
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85122354885&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85122354885&partnerID=8YFLogxK
U2 - 10.1007/s10620-021-07364-w
DO - 10.1007/s10620-021-07364-w
M3 - Article
C2 - 34993682
AN - SCOPUS:85122354885
VL - 67
SP - 4813
EP - 4826
JO - American Journal of Digestive Diseases
JF - American Journal of Digestive Diseases
SN - 0002-9211
IS - 10
ER -