Gloudemans, Bas (2023) Endoscopic resection of early esophageal neoplasia in patients with esophageal varices: a systematic review and case series. thesis, Medicine.
Full text available on request.Abstract
BACKGROUND AND AIMS Although endoscopic resection is an accepted treatment modality for early esophageal neoplasia, patients with concurrent esophageal varices are considered a high risk group due to an increased bleeding tendency. This study aimed to assess the safety and efficacy of endoscopic resection in this specific patient category, through a systematic review of the current literature followed by a retrospective multicenter cohort study. METHODS For the systematic review, Pubmed and Embase were screened for all literature reporting on the clinical outcomes of esophageal endoscopic resection in patients with esophageal varices. Screening, data extraction and quality assessment were conducted in accordance with PRISMA guidelines. Subsequently, patients with esophageal varices who underwent endoscopic resection in three Dutch tertiary centers between 2014 and 2022 were included through systematical screening of endoscopy databases. Safety and efficacy were evaluated based on resection rates, complication rate and mortality rate. RESULTS Histologically complete resection was achieved in 40/51 (78%) endoscopic resection procedures in literature and 17/20 (85%) procedures in our cohort, while curative resection was achieved in 13/20 (65%) patients in our cohort. Bleeding occurred in six cases (11%) in literature and 2 cases (10%) in our cohort, but could be managed endoscopically or conservatively in all cases. Two patients in literature (4%) additionally required transfusion during endoscopic submucosal dissection procedures that were partly complicated by submucosal fibrosis and operator inexperience. Markedly, 6/8 (75%) reported bleedings occurred after prophylactic endoscopic variceal ligation. CONCLUSION Endoscopic resection appears to be a safe and effective option in selected patients with concurrent esophageal neoplasia and esophageal varices, provided that the procedure is performed by an experienced endoscopist with adequate prophylaxis to prevent bleeding.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Alkhalaf, dr. Alaa and Frederiks, drs. Charlotte |
| Faculty: | Medical Sciences |
| Date Deposited: | 19 Apr 2023 12:59 |
| Last Modified: | 19 Apr 2023 12:59 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3483 |
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