Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jul 16, 2021; 13(7): 210-220
Published online Jul 16, 2021. doi: 10.4253/wjge.v13.i7.210
Gastrointestinal endoscopy in cirrhotic patient: Issues on the table
Giuseppe Grassi, Ilaria Lenci, Alessandro Signorello, Martina Milana, Leonardo Baiocchi
Giuseppe Grassi, Ilaria Lenci, Alessandro Signorello, Martina Milana, Leonardo Baiocchi, Hepatology Unit, University of Tor Vergata, Rome 00100, Italy
Author contributions: Grassi G carried out data collection, analysis and interpretation, drafting of manuscript, critical revision; Lenci I, Signorello A, and Milana M carried out data collection and critical revision; Baiocchi L performed the proposal of study, study conception, correction of manuscript, critical revision.
Conflict-of-interest statement: None to disclose by all authors.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Leonardo Baiocchi, MD, PhD, Associate Professor, Hepatology Unit, University of Tor Vergata, Viale Oxford 81, Rome 00100, Italy.
Received: April 29, 2021
Peer-review started: April 29, 2021
First decision: June 17, 2021
Revised: June 22, 2021
Accepted: June 28, 2021
Article in press: June 28, 2021
Published online: July 16, 2021

Patients with liver cirrhosis are fragile and present specific clinical hallmarks. When undergoing to gastrointestinal (GI) endoscopy, these subjects require an individual pre evaluation, taking into account: Level of haemostasis impairment, the individual risk of infection, the impact of sedation on hepatic encephalopathy and other factors. The overall assessment of liver function, employing common scoring systems, should be also assessed in the preprocedural phase. Beside some common general problems, regarding GI endoscopy in cirrhotic subjects, also specific issues are present for some frequent indications or procedures. For instance, despite an increased incidence of adenomas in cirrhosis, colon cancer screening remains suboptimal in subjects with this disease. Several studies in fact demonstrated liver cirrhosis as a negative factor for an adequate colon cleansing before colonoscopy. On the other hand, also the routine assessment of gastroesophageal varices during upper GI endoscopy presents some concern, since important inter-observer variability or incomplete description of endoscopic findings has been reported in some studies. In this review we discussed in details the most relevant issues that may be considered while performing general GI endoscopic practice, in patient with cirrhosis. For most of these issues there are no guidelines or clear indications. Moreover until now, few studies focused on these aspects. We believe that targeting these issues with corrective measures may be helpful to develop a tailored endoscopic approach for cirrhosis, in the future.

Keywords: Gastrointestinal endoscopy, Cirrhosis, Sedation, Infection, Gastroesophageal varices, Colonoscopy, Bowel cleansing, Liver transplantation

Core Tip: In this minireview, we discuss some issues that are encountered while performing general gastrointestinal endoscopy in cirrhotic patients. The solution of these aspects may increase, in the future, the yield of this technique in subjects with significant liver disease.