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.
Surg Endosc. 2011 Jun;25(6):1994-9. doi: 10.1007/s00464-010-1500-5. Epub 2010 Dec 7.
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.
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).
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).
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.
对于慢性肾衰竭（CRF）或肝硬化（LC）患者，内镜黏膜下剥离术（ESD）和内镜黏膜切除术（EMR）的可行性知之甚少。本研究旨在评估与无 CRF 或 LC 的患者相比，CRF 或 LC 患者接受 EMR 或 ESD 的安全性、疗效和临床结局。
2003 年 2 月至 2009 年 11 月，共对 928 例患者的 1016 个胃肿瘤病变进行了 EMR 或 ESD 治疗。其中 18 例患者患有 LC，17 例患者患有 CRF。回顾性分析其病历。比较 CRF 或 LC 患者与无 CRF 或 LC 的患者（对照组）之间的整块切除率、组织学完全切除率、手术时间和并发症。
CRF、LC 和对照组之间的基线特征除了 CRF 组合并症发生率高和 LC 组凝血酶原时间延长外，并无显著差异。手术时间和整块及完全切除率等治疗效果无显著差异。CRF+LC 组即刻出血发生率高于对照组（47.5% vs. 33.9%，p=0.077）。CRF、LC 和对照组之间的穿孔发生率无显著差异。CRF+LC 组的住院时间长于对照组（6.4±3.53 天 vs. 4.9±3.15 天，p=0.012）。
与对照组相比，CRF 或 LC 组患者接受 EMR 和 ESD 治疗早期胃肿瘤可能同样有效且耐受良好，尽管 CRF 或 LC 患者的住院时间可能长于对照组。
