Gastric Endoscopic Mucosal Resection and Polypectomy among Patients with Liver Cirrhosis and Esophageal Varices in the setting of acute upper gastrointestinal bleeding | ||
| African Journal of Gastroenterology and Hepatology | ||
| Volume 6, Issue 1, 2023, Pages 60-82 PDF (689.67 K) | ||
| Document Type: Original Clinical | ||
| DOI: 10.21608/ajgh.2023.209532.1032 | ||
| Authors | ||
| Bassam Mansour Salama* 1; Amir Abd-elhameed Ahmed Barakat2; Mahmoud sharafeddin2; Ahmed Gad2 | ||
| 1Infectious and Endemic diseases department. Faculty of Medicine. Suez Canal University, Egypt | ||
| 2Internal 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 | ||
| Gastric polypectomy; liver cirrhosis; post polypectomy bleeding; portal hypertension | ||
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