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Clinical outcomes of endoscopic submucosal dissection for early gastric cancer in patients with chronic kidney disease
Author(s) -
Numata Norifumi,
Oka Shiro,
Tanaka Shinji,
Higashiyama Makoto,
Sanomura Yoji,
Yoshida Shigeto,
Arihiro Koji,
Chayama Kazuaki
Publication year - 2013
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.12320
Subject(s) - medicine , hemodialysis , kidney disease , surgery , perforation , endoscopic submucosal dissection , cancer , gastroenterology , punching , materials science , metallurgy
Background and Aim Endoscopic submucosal dissection ( ESD ) is a widely accepted treatment for early gastric cancer ( EGC ), and the number of ESD performed for EGC in patients with chronic kidney disease ( CKD ) is increasing. Although patients undergoing hemodialysis tend to bleed and are at high risk for cardiovascular disease, the effectiveness and safety of ESD for EGC in patients with CKD in particular have not been established. The aim of this study was to evaluate the effectiveness and potential adverse effects of ESD for EGC in patients with CKD undergoing hemodialysis. Methods Sixty‐three consecutive CKD patients in whom 79 EGC s were treated by ESD between O ctober 2004 and J anuary 2012; 15 of the 63 patients were hemodialysis patients. Complete en bloc resection rate and ESD ‐related complications in hemodialysis patients versus non‐hemodialysis patients were evaluated. Results The complete en bloc resection rate was 100% (15/15) in the hemodialysis patients and 87.5% (56/64) in the non‐hemodialysis patients, respectively. The post‐ ESD bleeding rate was 33% (5/15) and 9% (6/64), respectively ( P < 0.05). Perforation occurred only in non‐hemodialysis patients; the incidence was 5% (3/64). Two ESD ‐related deaths occurred among hemodialysis patients (13%, 2/15); femoral artery infarction triggered post‐ ESD bleeding in one of these two patients, and alveolar hemorrhage occurred in the other. Conclusion Hemodialysis poses a risk of post‐ ESD bleeding. We must understand this risk and provide countermeasures for post‐ ESD bleeding in hemodialysis patients.