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.
Similar content being viewed by others
References
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
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
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
Gotoda T (2007) Endoscopic resection of early gastric cancer. Gastric Cancer 10:1–11
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
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
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
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
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
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
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
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
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
Douard R, Lentschener C, Ozier Y, Dousset B (2009) Operative risks of digestive surgery in cirrhotic patients. Gastroenterol Clin Biol 33:555–564
National Kidney Foundation (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39:S1–S266
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
Szaloki T, Toth V, Tiszlavicz L, Czako L (2006) Diagnostic and therapeutic use of endoscopic resection of gastric mucosa. Orv Hetil 147:501–507
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
Kaw D, Malhotra D (2006) Platelet dysfunction and end-stage renal disease. Semin Dial 19:317–322
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
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
Corresponding author
Rights 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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-010-1500-5