S2182 Short Term Outcomes of Endoscopic Submucosal Dissection (ESD) vs Endoscopic Mucosal Resection (EMR) in Patients With Cirrhosis

Introduction: Endoscopic Submucosal Dissection (ESD) and Endoscopic Mucosal Resection (EMR) are endoscopic techniques utilized for managing gastrointestinal lesions. In cirrhotic patients, procedural safety is a significant concern. This study compares short-term outcomes between ESD and EMR in cirrhotic patients using real-world data from a global health research network. Methods: We used the TriNetX database, a global federated network with data from numerous healthcare organizations. We identified cirrhotic patients with ESD and EMR using CPT and ICD-10 codes and excluded those with same day endoscopic management of gastrointestinal bleeding (GIB). We identified 391 patients in ESD cohort and 1279 patients in the EMR cohort. We then performed 1:1 propensity matching for demographics (age, sex, race, and ethnicity); co-morbidities (diabetes, heart failure, COPD, and chronic kidney disease); MELD labs; Medications use (anticoagulants, anti-platelets, beta blockers use). Co-primary outcomes included perforation, ICU Transfer, GIB, blood transfusions. Odds ratios (ORs) with 95% confidence intervals (CIs) were obtained for all outcomes save for mortality, for which Cox regression analysis was done to obtain hazard ratio (HR) at 2 years. Results: After propensity score matching, each group contained 286 patients on both groups with a median 30 days follow up. The matched cohorts were predominantly white and man. Both groups had similar number of patients with medical co-morbidities and had similar labs. Perforation occurred in 0% of patients in the ESD cohort compared to 3.5% in the EMR cohort (risk difference: -0.035, P = 0.001). There were no ICU transfers in either cohort. GIB occurred during the 30 day follow up in 3.5% of patients in both cohorts (P = 1). Blood transfusion was required in 0% of ESD patients versus 3.5% in the EMR group (risk difference: -0.035, P = 0.001). Conclusion: In cirrhotic patients, ESD appears to have a comparable or slightly safer short-term safety profile compared to EMR, with significantly fewer cases of perforation and transfusion. These findings support the consideration of ESD as a safe therapeutic option in appropriately selected cirrhotic patients.