Fatal outcome following gastric endoscopic submucosal dissection in a patient with liver cirrhosis

Abstract

A 73-year-old woman was admitted to hospital for management of early gastric cancer. Esophagogastroduodenoscopy (EGD) demonstrated a 2-cm elevated mucosal lesion with a central depression on the lesser curvature of the distal antrum, which after forceps biopsy was confirmed histopathologically to be a well-differentiated adenocarcinoma ([Fig. 1]). The patient’s medical history was significant for liver cirrhosis related to hepatitis C virus, hypertension, and type 2 diabetes mellitus. She had been monitored for 3 years for Child–Pugh class A liver cirrhosis. Her vital signs were stable. Her laboratory test results were as follows: white blood cell count 2.2 × 109/L, hemoglobin 9.1 g/L, platelet count 62 × 109/L, creatinine 0.8 mg/dL, albumin 3.2 g/dL, aspartate aminotransferase 90 U/L, alanine aminotransferase 54 U/L, and glucose 129 mg/dL. Abdominal computed tomography (CT) confirmed the presence of liver cirrhosis with splenomegaly. An endoscopic submucosal dissection (ESD) was performed using propofol and midazolam for balanced sedation. The lesion was successfully removed in 85 minutes and no adverse event occurred. The tumor was confined within the muscularis mucosa without lymphovascular involvement and the resection margins were clear.