Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
Gastric Cancer. 2019 Jan;22(1):164-171. doi: 10.1007/s10120-018-0848-4. Epub 2018 Jun 12.
Little is known about the outcomes of gastric endoscopic submucosal dissection (ESD) in patients with chronic kidney disease (CKD). We compared the efficacy and safety of ESD between CKD and non-CKD patients.
From January 2005 to December 2014, 102 CKD patients underwent ESD for gastric neoplasms at a tertiary medical institution were reviewed retrospectively. A propensity score-matched control group (102 patients) was selected from non-CKD patients to compare clinical outcomes between CKD and non-CKD patients.
En bloc resection (96.1%) and curative resection (88.2%) rates in the CKD group did not significantly differ from those in the non-CKD group. Median procedure times (25.0 vs. 21.5 min, p = 0.734) and perforation risk (p = 0.480) were similar between groups. The CKD group showed a tendency towards more bleeding events (p = 0.052) and had a significantly longer hospital stay (p = 0.001). In a subgroup analysis, stage 3 CKD patients exhibited a bleeding risk comparable to that exhibited by non-CKD patients (HR 1.35; 95% CI 0.36-5.06; p = 0.654), whereas stage 4 (HR 5.79; 95% CI 1.52-22.0; p = 0.010) and stage 5 (HR 4.80; 95% CI 1.58-14.6; p = 0.006) patients showed higher bleeding risks than non-CKD patients. In a multivariate analysis, stage 4/5 CKD was a significant predictor for bleeding risk (HR 4.99; 95% CI 1.32-18.8; p = 0.018).
ESD for gastric epithelial neoplasms can be performed in stage 3 CKD patients with comparable efficacy and safety to that performed in non-CKD patients. Stage 4 and 5 CKD patients should be closely monitored for bleeding events after ESD.
对于慢性肾脏病（CKD）患者的胃内镜黏膜下剥离术（ESD）的结果知之甚少。我们比较了 CKD 患者与非 CKD 患者 ESD 的疗效和安全性。
从 2005 年 1 月至 2014 年 12 月，回顾性分析了在一家三级医疗机构因胃肿瘤接受 ESD 的 102 例 CKD 患者。从非 CKD 患者中选择了 102 例倾向评分匹配的对照组患者，以比较 CKD 患者与非 CKD 患者的临床结局。
CKD 组整块切除（96.1%）和治愈性切除（88.2%）率与非 CKD 组无显著差异。两组间的中位手术时间（25.0 与 21.5 分钟，p=0.734）和穿孔风险（p=0.480）相似。CKD 组出血事件的发生率更高（p=0.052），住院时间更长（p=0.001）。在亚组分析中，3 期 CKD 患者的出血风险与非 CKD 患者相似（HR 1.35；95%CI 0.36-5.06；p=0.654），而 4 期（HR 5.79；95%CI 1.52-22.0；p=0.010）和 5 期（HR 4.80；95%CI 1.58-14.6；p=0.006）患者的出血风险高于非 CKD 患者。多变量分析显示，4/5 期 CKD 是出血风险的显著预测因素（HR 4.99；95%CI 1.32-18.8；p=0.018）。
对于胃上皮性肿瘤，ESD 可在与非 CKD 患者相当的疗效和安全性下在 3 期 CKD 患者中进行。ESD 后应密切监测 4 期和 5 期 CKD 患者的出血事件。
