Jin Byung Chul, Kim Dong Hyun, Seo Geom-Seog, Kim Sang-Wook, Oh Hyung-Hoon, Song Hyo-Yeop, Kim Seong-Jung, Joo Young-Eun, Lee Jun, Kim Hyun-Soo
Department of Internal Medicine, Research Institute of Clinical Medicine, Biomedical Research Institute, Jeonbuk National University Medical School, Jeonbuk National University, Jeonju 54907, Republic of Korea.
Department of Internal Medicine, Medical School, Chonnam National University, Gwangju 61469, Republic of Korea.
Diagnostics (Basel). 2024 Jul 8;14(13):1459. doi: 10.3390/diagnostics14131459.
Colorectal neoplasms are prevalent in patients with chronic kidney disease (CKD); however, the safety and efficacy of colorectal endoscopic submucosal dissection (ESD) are not well understood. This retrospective analysis included ESD procedures performed in 1266 patients with CKD across five tertiary medical institutions from January 2015 to December 2020. Patients were categorized based on their estimated glomerular filtration rate (eGFR), which ranged from CKD1 to CKD5 (including those on dialysis). We found that en bloc resection rates remained high across all CKD stages, affirming the procedural efficacy of ESD. Notably, the prevalence of cardiovascular comorbidities, such as ischemic heart disease and diabetes mellitus, significantly increased with an advancing CKD stage, with a corresponding increase in the Charlson Comorbidity Index, highlighting the complexity of managing these patients. Despite these challenges, the complete resection rate was lower in the CKD5 group (50%) than in the CKD1 group (83.4%); however, procedural complications, such as perforation and bleeding, did not significantly differ among the groups. The predictive models for complete resection and major complications showed no significant changes with a decreasing eGFR. These findings underscore that ESD is a feasible and safe treatment for colorectal neoplasms in patients with CKD, successfully balancing the inherent procedural risks with clinical benefits.
结直肠肿瘤在慢性肾脏病（CKD）患者中很常见；然而，结直肠内镜黏膜下剥离术（ESD）的安全性和有效性尚未得到充分了解。这项回顾性分析纳入了2015年1月至2020年12月期间在五家三级医疗机构对1266例CKD患者进行的ESD手术。患者根据其估计肾小球滤过率（eGFR）进行分类，范围从CKD1到CKD5（包括透析患者）。我们发现，在所有CKD阶段，整块切除率都很高，证实了ESD的手术疗效。值得注意的是，随着CKD阶段的进展，心血管合并症如缺血性心脏病和糖尿病的患病率显著增加，查尔森合并症指数相应升高，凸显了管理这些患者的复杂性。尽管存在这些挑战，但CKD5组的完整切除率（50%）低于CKD1组（83.4%）；然而，各组之间穿孔和出血等手术并发症并无显著差异。完整切除和主要并发症的预测模型并未随着eGFR的降低而出现显著变化。这些发现强调，ESD对于CKD患者的结直肠肿瘤是一种可行且安全的治疗方法，成功地在手术固有风险和临床益处之间取得了平衡。
