Endoscopic Management of Gastrointestinal Cancer in Cirrhotic Patients

Patients with liver cirrhosis are at heightened risk of developing upper gastrointestinal malignancies, particularly oesophageal and gastric cancers, owing to factors such as portal hypertension, mucosal congestion and impaired immune surveillance. Traditional surgical approaches carry unacceptable morbidity and mortality in those with compromised hepatic reserve and coagulopathy. Endoscopic techniques have emerged as minimally invasive alternatives that can achieve curative resection in early‐stage lesions while mitigating perioperative risk. Critical considerations include precise assessment of liver function using the Child–Pugh classification or Model for End‐Stage Liver Disease score, management of coagulopathy, and prophylaxis against variceal bleeding. Endoscopic submucosal dissection and mucosal resection allow en bloc removal of neoplastic tissue, whereas adjunctive measures—such as pre‐procedural variceal obliteration, haemostatic injection and dedicated clipping devices—enhance safety. Interdisciplinary collaboration between hepatology, endoscopy and anaesthesia teams is essential to optimise patient selection, tailor prophylactic strategies and ensure vigilant peri‐procedural monitoring. Advances in imaging guidance and novel haemostatic agents promise to extend the applicability of endoscopic therapy to a broader spectrum of cirrhotic patients, aligning oncological efficacy with preservation of hepatic function.

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Endoscopic Management of Gastrointestinal Cancer in Cirrhotic Patients publication trend

The graph below shows the total number of articles in endoscopic management of gastrointestinal cancer in cirrhotic patients across all publications each year (not limited to Nature Index journals).

Technical terms

Endoscopic submucosal dissection (ESD): A technique for en bloc removal of superficial neoplastic lesions by dissecting within the submucosal layer.

Portal hypertension: Elevated pressure in the portal venous system causing mucosal congestion and oesophageal or gastric varices.

Child–Pugh classification: A scoring system based on bilirubin, albumin, prothrombin time, ascites and encephalopathy to assess cirrhosis severity.

Endoscopic mucosal resection (EMR): A method to remove superficial lesions by lifting the mucosa and excising it with a snare.

Variceal obliteration prophylaxis: Preventive endoscopic interventions, such as band ligation or sclerotherapy, to eradicate oesophageal varices and reduce bleeding risk.

References

1. Upper Gastrointestinal Cancer and Liver Cirrhosis. Cancers (2022).
2. Preoperative Transient Elastography in Patients with Esophageal Cancer. Diagnostics (2022).
3. Endoscopic Submucosal Dissection for Treatment of Early-Stage Cancer or Precancerous Lesion in the Upper Gastrointestinal Tract in Patients with Liver Cirrhosis. Journal of Clinical Medicine (2023).
4. Endoscopic resection of early esophageal neoplasia in patients with esophageal varices: a systematic review. Endoscopy (2025).