Gastric Endoscopic Mucosal Resection and Polypectomy among Patients with Liver Cirrhosis and Esophageal Varices in the setting of acute upper gastrointestinal bleeding

Document Type : Original Clinical

Authors

1 Infectious and Endemic diseases department. Faculty of Medicine. Suez Canal University, Egypt

2 Internal medicine department, gastroenterology, and hepatology unit; Faculty of Medicine Zagazig University, Egypt.

Abstract

Background
Gastric polyps are not infrequently reported among cirrhotic patients. Endoscopic resection of gastric polyps among patients with liver cirrhosis and esophageal varices carries the risk of post-polypectomy bleeding. This may explain why endoscopists are reluctant to its excision.
 
The aim is to evaluate the incidence of immediate (intraoperative) and delayed (within 30 days) post-polypectomy bleeding among cirrhotic patients with esophageal varices and portal ‎hypertension and determine its risk factors.
Methods‎
This study comprised 39 cirrhotic patients with portal hypertension and varices who presented with gastrointestinal bleeding, and they had gastric polyps detected during the endoscopic intervention to control the acute bleeding or during follow-up. All patients were exposed to the entire history, clinical examination, and basic laboratory workup. Esophagogastroduodenoscopy was done to combine bleeding control and polypectomy simultaneously.
Results
Immediate (intraoperative) post-polypectomy bleeding occurred in 38.8% of patients, and no delayed bleeding was reported. Most of the reported bleeding was mild and clinically non-significant, and it stopped spontaneously or endoscopically. Furthermore, no mortality was reported.
The risk of immediate (intraoperative) bleeding significantly increased with advanced age, advanced liver disease, increased portal hypertension with large varices, and decreased platelet count; meanwhile, the sex of patients, size, location, and method of polypectomy did not significantly increase the risk of gastric post-polypectomy bleeding among cirrhotic patients with portal hypertension and esophageal varices.
Conclusions.
Among patients with cirrhosis and portal hypertension, gastric polypectomy simultaneously done during endoscopic intervention for esophageal varices is considered a safe maneuver.

Keywords

Footnotes. Peer-Reviewers: Emad Hamed (professor of internal medicine), Mohamed Emara (professor of tropical medicine), Samah Soliman (professor of tropical medicine), and Amr Shaban Hanafy (professor of internal medicine)., Nevin Fouad (professor of internal medicine). E- Editor: Salem Youssef Mohamed, Osama Ahmed Khalil. Copyright ©. This open-access article is distributed under the Creative Commons Attribution License (CC BY). The use, distribution, or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited. The original publication in this journal is cited by accepted academic practice. No use, distribution, or reproduction is permitted, complying with these terms. Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent their affiliated organizations or those of the publisher, the editors, and the reviewers. Any product evaluated in this article or its manufacturer's claim is not guaranteed or endorsed by the publisher. Data availability All the data obtained and analyzed are included in this manuscript. Conflicts of interest The authors declare that they have no competing interests. Funding source The authors funded this study on their own. Authors’ contributions Bassam Mansour Salama‎and Amir Abd-Elhameed Ahmed Barakat conceived and supervised the work. Mahmoud Ahmed Sharafeddin and Ahmed Ibrahim Gad planned and conducted the experiments. All authors analyzed the data. All authors wrote the manuscript. All authors read and approved the final manuscript.

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