Skip to main content
SpringerLink
Log in

Endoscopic treatments of gastric mucosal lesions are not riskier in patients with chronic renal failure or liver cirrhosis

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Little is known about the feasibility of endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for patients with chronic renal failure (CRF) or liver cirrhosis (LC). This study aimed to assess the safety, efficacy, and clinical outcomes of EMR or ESD in patients with CRF or LC compared to those in patients without.

Methods

Between February 2003 and November 2009, a total of 1016 gastric neoplastic lesions in 928 patients were treated by using EMR or ESD. Among them, 18 patients had LC and 17 patients had CRF. Their medical records were reviewed retrospectively. En bloc resection rate, histological complete resection rate, operation time, and complications were compared between patients with CRF or LC and those without (control group).

Results

Baseline characteristics were not significantly different between the CRF, LC, and control groups except for a high rate of comorbidities in the CRF group and prolonged prothrombin time in the LC group. Operation time and therapeutic outcomes such as en bloc and complete resection rates did not differ significantly between the groups. Immediate bleeding tended to occur more frequently in the CRF + LC group than in controls (47.5 vs. 33.9%, p = 0.077). There was no significant difference in the incidence of perforation between the CRF, LC, and control groups. The hospital stay was longer in the CRF + LC group than in the control group (6.4 ± 3.53 vs. 4.9 ± 3.15 days, p = 0.012).

Conclusions

EMR and ESD for the treatment of early gastric neoplasia may be equally effective and tolerable in the CRF or the LC group compared to the control group, although patients with CRF or LC might need the longer admission period than the control group.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Chung IK, Lee JH, Lee SH, Kim SJ, Cho JY, Cho WY, Hwangbo Y, Keum BR, Park JJ, Chun HJ, Kim HJ, Kim JJ, Ji SR, Seol SY (2009) Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD Study Group multicenter study. Gastrointest Endosc 69:1228–1235

    Article  PubMed  Google Scholar 

  2. Oka S, Tanaka S, Kaneko I, Mouri R, Hirata M, Kawamura T, Yoshihara M, Chayama K (2006) Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Gastrointest Endosc 64:877–883

    Article  PubMed  Google Scholar 

  3. Kim JJ, Lee JH, Jung HY, Lee GH, Cho JY, Ryu CB, Chun HJ, Park JJ, Lee WS, Kim HS, Chung MG, Moon JS, Choi SR, Song GA, Jeong HY, Jee SR, Seol SY, Yoon YB (2007) EMR for early gastric cancer in Korea: a multicenter retrospective study. Gastrointest Endosc 66:693–700

    Article  PubMed  Google Scholar 

  4. Gotoda T (2007) Endoscopic resection of early gastric cancer. Gastric Cancer 10:1–11

    Article  PubMed  Google Scholar 

  5. Hirao M, Masuda K, Asanuma T, Naka H, Noda K, Matsuura K, Yamaguchi O, Ueda N (1988) Endoscopic resection of early gastric cancer and other tumors with local injection of hypertonic saline-epinephrine. Gastrointest Endosc 34:264–269

    Article  PubMed  CAS  Google Scholar 

  6. Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, Hosokawa K, Shimoda T, Yoshida S (2001) Endoscopic mucosal resection for treatment of early gastric cancer. Gut 48:225–229

    Article  PubMed  CAS  Google Scholar 

  7. Gotoda T, Kondo H, Ono H, Saito Y, Yamaguchi H, Saito D, Yokota T (1999) A new endoscopic mucosal resection procedure using an insulation-tipped electrosurgical knife for rectal flat lesions: report of two cases. Gastrointest Endosc 50:560–563

    Article  PubMed  CAS  Google Scholar 

  8. Yamamoto H, Kawata H, Sunada K, Sasaki A, Nakazawa K, Miyata T, Sekine Y, Yano T, Satoh K, Ido K, Sugano K (2003) Successful en-bloc resection of large superficial tumors in the stomach and colon using sodium hyaluronate and small-caliber-tip transparent hood. Endoscopy 35:690–694

    Article  PubMed  CAS  Google Scholar 

  9. Okano A, Hajiro K, Takakuwa H, Nishio A, Matsushita M (2003) Predictors of bleeding after endoscopic mucosal resection of gastric tumors. Gastrointest Endosc 57:687–690

    Article  PubMed  Google Scholar 

  10. Martinez Mier G, Alvarez-Tostado Fernandez JF, Romero Hernandez T, Martinez Mier EA, Blanco Benavides R (1999) Morbidity and mortality in surgery for gastric cancer. Rev Gastroenterol Mex 64:78–84

    PubMed  CAS  Google Scholar 

  11. Newman LA, Mittman N, Hunt Z, Alfonso AE (1999) Survival among chronic renal failure patients requiring major abdominal surgery. J Am Coll Surg 188:310–314

    Article  PubMed  CAS  Google Scholar 

  12. Ogura K, Okamoto M, Sugimoto T, Yahagi N, Fujishiro M, Kakushima N, Kodashima S, Kawabe T, Omata M (2008) Efficacy and safety of endoscopic submucosal dissection for gastric cancer in patients with liver cirrhosis. Endoscopy 40:443–445

    Article  PubMed  CAS  Google Scholar 

  13. Goto O, Fujishiro M, Kodashima S, Ono S, Niimi K, Yamamichi N, Omata M (2010) Feasibility of endoscopic submucosal dissection for patients with chronic renal failure on hemodialysis. Dig Endosc 22:45–48

    Article  PubMed  Google Scholar 

  14. Douard R, Lentschener C, Ozier Y, Dousset B (2009) Operative risks of digestive surgery in cirrhotic patients. Gastroenterol Clin Biol 33:555–564

    Article  PubMed  CAS  Google Scholar 

  15. National Kidney Foundation (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39:S1–S266

    Google Scholar 

  16. Marin-Gabriel JC, Solis-Herruzo JA (2009) Noninvasive assessment of liver fibrosis. Serum markers and transient elastography (FibroScan). Rev Esp Enferm Dig 101:787–799

    Article  PubMed  CAS  Google Scholar 

  17. Szaloki T, Toth V, Tiszlavicz L, Czako L (2006) Diagnostic and therapeutic use of endoscopic resection of gastric mucosa. Orv Hetil 147:501–507

    PubMed  Google Scholar 

  18. Kim BJ, Chang TH, Kim JJ, Min BH, Lee JH, Son HJ, Rhee PL, Rhee JC, Kim KM, Park CK (2010) Efficacy and safety of endoscopic submucosal dissection for early gastric cancer in patients with comorbid diseases. Gut Liver 4:186–191

    Article  PubMed  Google Scholar 

  19. Kaw D, Malhotra D (2006) Platelet dysfunction and end-stage renal disease. Semin Dial 19:317–322

    Article  PubMed  Google Scholar 

  20. Watanabe K, Ogata S, Kawazoe S, Koyama T, Kajiwara T, Shimoda Y, Takase Y, Irie K, Mizuguchi M, Tsunada S, Iwakiri R, Fujimoto K (2006) Clinical outcomes of EMR for gastric tumors: historical pilot evaluation between endoscopic submucosal dissection and conventional mucosal resection. Gastrointest Endosc 63:776–782

    Article  PubMed  Google Scholar 

Download references

Disclosures

Young Lan Kwon, Eun Soo Kim, Kyung In Lee, Yong Jin Kim, Chang Wook Park, Yun Jung Kim, Hye Jin Seo, Kwang Bum Cho, Kyung Sik Park, Byoung Kuk Jang, Woo Jin Chung, and Jae Seok Hwang have no conflicts of interest of financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Institute of Gastroenterology and Hepatology, Keimyung University School of Medicine, 194 Dong San-dong, Jung-gu, Daegu, 700-712, South Korea

    Young Lan Kwon, Eun Soo Kim, Kyung In Lee, Yong Jin Kim, Chang Wook Park, Yun Jung Kim, Hye Jin Seo, Kwang Bum Cho, Kyung Sik Park, Byoung Kuk Jang, Woo Jin Chung & Jae Seok Hwang

Authors
  1. Young Lan Kwon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eun Soo Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kyung In Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yong Jin Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chang Wook Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yun Jung Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hye Jin Seo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kwang Bum Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kyung Sik Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Byoung Kuk Jang
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Woo Jin Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Jae Seok Hwang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eun Soo Kim.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kwon, Y.L., Kim, E.S., Lee, K.I. et al. Endoscopic treatments of gastric mucosal lesions are not riskier in patients with chronic renal failure or liver cirrhosis. Surg Endosc 25, 1994–1999 (2011). https://doi.org/10.1007/s00464-010-1500-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-010-1500-5

Keywords

Search

Navigation