Endoscopic therapy strategy for upper gastrointestinal early cancer complicated with esophagogastric varices

Abstract Background: Endoscopic ligation and histoacryl injection have become the main methods for esophagogastric varices (EGV) in cirrhosis patients. And endoscopic submucosal dissection (ESD) has been widely used in the treatment of early gastrointestinal cancer. The present study aims to discuss the endoscopic therapy strategy for upper gastrointestinal early cancer in cirrhotic patients companied with EGV.Methods: This study retrospectively analyzed the clinical data and endoscopic treatment characteristics of 12 patients with cirrhosis complicated with both EGV and early tumor of the upper digestive tract.Results: The therapeutic decision depends on the relative location of early cancer to EGV and the general condition of patients. The international normalized ratio (INR) should be corrected to be no more than 1.5 and the platelet count no less than 50×106/ml. The early cancers were dissected if the lesions were far from the EGV. On the other hand, the EGV should be treated first if the early cancers were close to the varices. En bloc resection was 100% (11/11) for all ESD procedures. The average operation time was 55 min (25-180 min). No significant complications were observed during the perioperative period. During an average follow-up time of 22.2 months (16-28 months), neither local recurrence nor enlarged lymph nodes was found. The remaining one patient lost the ESD chance due to the cancer progression after transjugular intrahepatic portosystemic shunt (TIPS) treatment.Conclusions: ESD is a safe and effective way to remove early gastrointestinal cancer in patients complicated with EGV after comprehensive evaluation.