Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Dig Endosc. 2010 Jan;22(1):45-8. doi: 10.1111/j.1443-1661.2009.00927.x.
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.
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.
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.
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.
内镜黏膜下剥离术（ESD）有望成为治疗无淋巴结转移的胃肠道癌症的一种根治性方法。对于终末期慢性肾衰竭（CRF）并接受血液透析的患者，ESD 的相关信息鲜为人知。我们旨在评估 ESD 治疗 CRF 并接受血液透析患者的疗效和安全性。
回顾性分析 2002 年 3 月至 2007 年 8 月期间，10 例连续患者的 12 处病变接受了 ESD（胃 7 例；结直肠 3 例），评估了 ESD 的技术可行性和并发症。
所有病变均整块切除且整块切除率为 100%。组织学显示所有病变均符合无淋巴结转移癌症的标准。1 例胃病变患者在 ESD 后第 1 天出现延迟性出血并需要输血，1 例结直肠病变患者在 ESD 后第 7 天出现分流阻塞并需要放射介入治疗。1 例结直肠病变患者在 ESD 后第 2 天出现延迟性穿孔并随后紧急手术。
ESD 治疗 CRF 患者可能具有技术可行性，但应考虑到较大的风险。为了防止并发症恶化，应在至少 1 周内进行强化医疗检查，以早期发现迟发性并发症。
