Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
J Gastroenterol Hepatol. 2013 Oct;28(10):1632-7. doi: 10.1111/jgh.12320.
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.
Sixty-three consecutive CKD patients in whom 79 EGCs were treated by ESD between October 2004 and January 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.
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.
Hemodialysis poses a risk of post-ESD bleeding. We must understand this risk and provide countermeasures for post-ESD bleeding in hemodialysis patients.
内镜黏膜下剥离术（ESD）是治疗早期胃癌（EGC）的一种广泛接受的方法，接受 ESD 治疗 EGC 的慢性肾脏病（CKD）患者数量正在增加。虽然接受血液透析的患者容易出血且心血管疾病风险较高，但尚未确定 ESD 治疗 CKD 患者 EGC 的有效性和安全性。本研究旨在评估 ESD 治疗 CKD 接受血液透析患者 EGC 的有效性和潜在不良影响。
2004 年 10 月至 2012 年 1 月，对 63 例连续 CKD 患者的 79 个 EGC 进行了 ESD 治疗，其中 15 例为血液透析患者。评估血液透析患者与非血液透析患者的整块切除率和 ESD 相关并发症。
血液透析患者的整块切除率为 100%（15/15），非血液透析患者为 87.5%（56/64）。ESD 后出血率分别为 33%（5/15）和 9%（6/64）（P<0.05）。穿孔仅发生在非血液透析患者中，发生率为 5%（3/64）。2 例血液透析患者发生与 ESD 相关的死亡（13%，2/15）；其中 1 例患者的股动脉梗塞导致 ESD 后出血，另 1 例患者发生肺泡出血。
血液透析增加了 ESD 后出血的风险。我们必须了解这种风险，并为血液透析患者的 ESD 后出血提供对策。
