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CC BY 4.0 · Endoscopy 2025; 57(07): 769-777
DOI: 10.1055/a-2524-4148
Systematic review

Endoscopic resection of early esophageal neoplasia in patients with esophageal varices: a systematic review

Charlotte N. Frederiks 
1   Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, Netherlands
2   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
,
Laura S. Boer
1   Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, Netherlands
2   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
,
Bas Gloudemans
2   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
,
Lorenza Alvarez Herrero
1   Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, Netherlands
,
Jacques J.G.H.M. Bergman
3   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam Gastroenterology Endocrinology and Metabolism, Cancer Center Amsterdam, Amsterdam, Netherlands
,
Roos E. Pouw
2   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
3   Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam Gastroenterology Endocrinology and Metabolism, Cancer Center Amsterdam, Amsterdam, Netherlands
,
Bas L.A.M. Weusten 
1   Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, Netherlands
2   Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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Abstract

Background

Although endoscopic resection (ER) is recommended as first-choice treatment for early esophageal neoplasia, patients with esophageal varices are considered a high-risk group owing to an increased risk of bleeding. This systematic review aimed to evaluate the effectiveness and safety of ER in this specific patient category.

Methods

We searched for studies reporting on clinical outcomes of ER in the presence of esophageal varices, irrespective of study design or follow-up time. End points included the incidence of prophylactic measures to reduce the risk of variceal hemorrhage, radical and curative resection rates, and adverse events.

Results

After screening 2371 studies, 42 studies (including our own unpublished cohort) with a total of 186 patients were included in this systematic review. Endoscopic band ligation (72/186; 39%) and endoscopic injection sclerotherapy (22/186; 12%) were the prophylactic measures most widely adopted to eradicate varices prior to ER. Other frequently described prophylactic measures included direct varix coagulation during ER (18/186; 10%) and the placement of a transjugular intrahepatic portosystemic shunt prior to ER (9/186; 5%). While the radical and curative resection rates were high (86% and 72%, respectively), the periprocedural and delayed bleeding risks were reported to be relatively low (6% and 3%, respectively). In all studies, no procedure-related mortality was observed.

Conclusions

ER appeared to be a safe and effective treatment option in selected patients with concurrent early esophageal neoplasia and esophageal varices, provided that a tailored approach of adequate prophylactic measures to prevent bleeding is applied.

Supplementary Material



Publication History

Received: 29 June 2024

Accepted after revision: 23 January 2025

Accepted Manuscript online:
24 January 2025

Article published online:
24 February 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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