FEASIBILITY OF ENDOSCOPIC SUBMUCOSAL DISSECTION FOR PATIENTS WITH CHRONIC RENAL FAILURE ON HEMODIALYSIS

Authors


Mitsuhiro Fujishiro, Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. Email: mtfujish-kkr@umin.ac.jp

Abstract

Background:  Endoscopic submucosal dissection (ESD) is expected as a curative method for node-negative gastrointestinal cancers. Little is known about ESD for patients with end-stage chronic renal failure (CRF) on hemodialysis. We aimed to evaluate the efficacy and safety of ESD for patients with CRF on hemodialysis.

Methods:  Ten consecutive patients with 12 lesions who underwent ESD (stomach, seven; colorectum, three) between March 2002 and August 2007 were retrospectively investigated in terms of the technical feasibility and complications.

Results:  All the lesions were resected in a single piece and en-bloc and R0 resection rate was 100%. Histology revealed that all the lesions fulfilled the criteria of node-negative cancers. Delayed bleeding requiring blood transfusion on the day after ESD, and shunt occlusion, which necessitated a radiological intervention 7 days after ESD, occurred in one stomach case. Delayed perforation followed by emergency surgery 2 days after ESD occurred in one colorectal case.

Conclusions:  ESD for CRF patients may be technically feasible, but substantial risks should be considered. Early detection of late-onset complications is essential with intensive medical check-up for at least 1 week in order to prevent complications from becoming severe.

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