ESD Is Safe and Effective for Esophageal Lesions in Cirrhotic Patients With Small Esophageal Varices

ESD Is Safe and Effective for Esophageal Lesions in Cirrhotic Patients With Small Esophageal Varices

Prateek Sharma, MD, FASGE, reviewing Mony S, et al. Endoscopy 2023 Aug 23.

Endoscopic submucosal dissection (ESD) is an effective strategy for complete resection of superficial esophageal neoplasia. However, such lesions in patients with cirrhosis and portal hypertension can be difficult to treat.

This was a multicenter, retrospective study of patients with cirrhosis (n=23) who underwent ESD for esophageal varices (EV) with superficial esophageal neoplasia. These patients had a lesion near or adjacent to the EV with a median lesion size of 30 mm and either squamous cell neoplasia (16 cases) or Barrett’s esophagus-related neoplasia (7 cases). The majority of patients had Child-Pugh Class B cirrhosis (56.5%) and small EV (86%). 

The study reported high rates of successful outcomes, including en bloc resection in 95.6% of patients, R0 resection in 91.3%, and curative resection in 82.6%. Intraprocedural bleeding occurred in 4.3% of patients but was managed endoscopically, and there were no instances of delayed perforation, hepatic decompensation, or deaths during follow-up (median, 36 months; interquartile range, 22-55). One case of local recurrence was observed after noncurative resection.

Prateek Sharma, MD, FASGE


ESD is a viable treatment choice for superficial esophageal lesions situated near or alongside small esophageal varices in individuals with cirrhosis. This procedure should be conducted in referral centers of expertise.


Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Mony S, Hu B, Joseph A, et al. Clinical outcomes of endoscopic submucosal dissection for superficial esophageal neoplasia in close proximity to esophageal varices: a multicenter international experience. Endoscopy 2023 Aug 23. (Epub ahead of print) (

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