Endoscopic treatments of gastric mucosal lesions are not riskier in patients with chronic renal failure or liver cirrhosis

• Published in: Surgical endoscopy Vol. 25; no. 6; pp. 1994 - 1999
• Main Authors: Kwon, Young Lan, Kim, Eun Soo, Lee, Kyung In, Kim, Yong Jin, Park, Chang Wook, Kim, Yun Jung, Seo, Hye Jin, Cho, Kwang Bum, Park, Kyung Sik, Jang, Byoung Kuk, Chung, Woo Jin, Hwang, Jae Seok
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.06.2011; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Adenocarcinoma - epidemiology; Adenocarcinoma - surgery; Aged; Biological and medical sciences; Chronic illnesses; Clinical outcomes; Comorbidity; Dissection - methods; Endoscopy; Endoscopy, Gastrointestinal - methods; Female; Gastroenterology; Gastroenterology. Liver. Pancreas. Abdomen; Gynecology; Hepatology; Hospitals; Humans; Kidney Failure, Chronic - epidemiology; Kidney Failure, Chronic - surgery; Length of Stay; Liver cirrhosis; Liver Cirrhosis - epidemiology; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Other diseases. Semiology; Patients; Proctology; Renal failure; Retrospective Studies; Stomach Neoplasms - epidemiology; Stomach Neoplasms - surgery; Surgery; Treatment Outcome; Germany; Liver cirrhosis; Chronic renal failure; Endoscopy; Kidney disease; Human; Endoscopic surgery; Stomach; Urinary system disease; Digestive system; Liver; Mucosa; Hepatic disease; Cirrhosis; Treatment; Digestive diseases
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-010-1500-5

Background 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. Methods 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). Results 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). Conclusions 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.