Cargando…

Renal dysfunction is an independent risk factor for bleeding after gastric ESD

Background and study aims: The number of patients with chronic kidney disease (CKD) is increasing worldwide and gastric cancer sometimes occurs with CKD. However, the safety and feasibility of endoscopic submucosal dissection (ESD) for patients with CKD are not clear. The aim of this study is to cla...

Descripción completa

Detalles Bibliográficos
Autores principales: Yoshioka, Teppei, Nishida, Tsutomu, Tsujii, Masahiko, Kato, Motohiko, Hayashi, Yoshito, Komori, Masato, Yoshihara, Harumasa, Nakamura, Takeshi, Egawa, Satoshi, Yoshio, Toshiyuki, Yamada, Takuya, Yabuta, Takamasa, Yamamoto, Katsumi, Kinoshita, Kazuo, Kawai, Naoki, Ogiyama, Hideharu, Nishihara, Akihiro, Michida, Tomoki, Iijima, Hideki, Shintani, Ayumi, Takehara, Tetsuo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: © Georg Thieme Verlag KG 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4423257/
https://www.ncbi.nlm.nih.gov/pubmed/26134770
http://dx.doi.org/10.1055/s-0034-1390762
_version_ 1782370180948557824
author Yoshioka, Teppei
Nishida, Tsutomu
Tsujii, Masahiko
Kato, Motohiko
Hayashi, Yoshito
Komori, Masato
Yoshihara, Harumasa
Nakamura, Takeshi
Egawa, Satoshi
Yoshio, Toshiyuki
Yamada, Takuya
Yabuta, Takamasa
Yamamoto, Katsumi
Kinoshita, Kazuo
Kawai, Naoki
Ogiyama, Hideharu
Nishihara, Akihiro
Michida, Tomoki
Iijima, Hideki
Shintani, Ayumi
Takehara, Tetsuo
author_facet Yoshioka, Teppei
Nishida, Tsutomu
Tsujii, Masahiko
Kato, Motohiko
Hayashi, Yoshito
Komori, Masato
Yoshihara, Harumasa
Nakamura, Takeshi
Egawa, Satoshi
Yoshio, Toshiyuki
Yamada, Takuya
Yabuta, Takamasa
Yamamoto, Katsumi
Kinoshita, Kazuo
Kawai, Naoki
Ogiyama, Hideharu
Nishihara, Akihiro
Michida, Tomoki
Iijima, Hideki
Shintani, Ayumi
Takehara, Tetsuo
author_sort Yoshioka, Teppei
collection PubMed
description Background and study aims: The number of patients with chronic kidney disease (CKD) is increasing worldwide and gastric cancer sometimes occurs with CKD. However, the safety and feasibility of endoscopic submucosal dissection (ESD) for patients with CKD are not clear. The aim of this study is to clarify the feasibility and safety of gastric ESD for patients with CKD. Patients and methods: This was a multicenter retrospective cohort study. In total, 144 patients with CKD who underwent gastric ESD between May 2003 and October 2012 were enrolled. The patients were divided into three groups: stage 3 (estimated glomerular filtration rate [eGFR]: 30 – 59 mL/min), stage 4 (eGFR: 15 – 29 mL/min), and stage 5 (eGFR: < 15 mL/min) according to the Kidney Disease Improving Global Outcomes Guidelines. The en bloc and curative resection rates and complications were assessed as short-term outcomes. Overall survival was analyzed using Kaplan – Meier methods. Results: In total, 92 patients were in stage 3 CKD; 23 in stage 4; and 29 in stage 5, including 19 patients in hemodialysis. The en bloc resection rate was 95.8 %. Post-ESD bleeding was observed in four patients with stage 5 CKD (13.8 %), three with stage 4 (13.0 %), and one with stage 3 (1.1 %). All bleeding could be controlled by endoscopic hemostasis, but five patients required blood transfusion. Perforation occurred in two patients (6.9 %) with stage 5 CKD, none (0 %) with stage 4, and two (4.3 %) with stage 3. Multivariate Poisson regression analysis revealed CKD stage 4 was a critical factor related to bleeding, whereas diabetes mellitus and CKD stage 5, which largely consist of patients receiving hemodialysis, were not. The median observation period of patients who achieved curative resection was 25.9 months (range 0.8—112.7 months) and the 3-year overall survival rate was 92.5 %. Conclusions: Estimated GFR is a significant independent predictive factor of post-ESD bleeding in patients with CKD.
format Online
Article
Text
id pubmed-4423257
institution National Center for Biotechnology Information
language English
publishDate 2015
publisher © Georg Thieme Verlag KG
record_format MEDLINE/PubMed
spelling pubmed-44232572015-06-23 Renal dysfunction is an independent risk factor for bleeding after gastric ESD Yoshioka, Teppei Nishida, Tsutomu Tsujii, Masahiko Kato, Motohiko Hayashi, Yoshito Komori, Masato Yoshihara, Harumasa Nakamura, Takeshi Egawa, Satoshi Yoshio, Toshiyuki Yamada, Takuya Yabuta, Takamasa Yamamoto, Katsumi Kinoshita, Kazuo Kawai, Naoki Ogiyama, Hideharu Nishihara, Akihiro Michida, Tomoki Iijima, Hideki Shintani, Ayumi Takehara, Tetsuo Endosc Int Open Article Background and study aims: The number of patients with chronic kidney disease (CKD) is increasing worldwide and gastric cancer sometimes occurs with CKD. However, the safety and feasibility of endoscopic submucosal dissection (ESD) for patients with CKD are not clear. The aim of this study is to clarify the feasibility and safety of gastric ESD for patients with CKD. Patients and methods: This was a multicenter retrospective cohort study. In total, 144 patients with CKD who underwent gastric ESD between May 2003 and October 2012 were enrolled. The patients were divided into three groups: stage 3 (estimated glomerular filtration rate [eGFR]: 30 – 59 mL/min), stage 4 (eGFR: 15 – 29 mL/min), and stage 5 (eGFR: < 15 mL/min) according to the Kidney Disease Improving Global Outcomes Guidelines. The en bloc and curative resection rates and complications were assessed as short-term outcomes. Overall survival was analyzed using Kaplan – Meier methods. Results: In total, 92 patients were in stage 3 CKD; 23 in stage 4; and 29 in stage 5, including 19 patients in hemodialysis. The en bloc resection rate was 95.8 %. Post-ESD bleeding was observed in four patients with stage 5 CKD (13.8 %), three with stage 4 (13.0 %), and one with stage 3 (1.1 %). All bleeding could be controlled by endoscopic hemostasis, but five patients required blood transfusion. Perforation occurred in two patients (6.9 %) with stage 5 CKD, none (0 %) with stage 4, and two (4.3 %) with stage 3. Multivariate Poisson regression analysis revealed CKD stage 4 was a critical factor related to bleeding, whereas diabetes mellitus and CKD stage 5, which largely consist of patients receiving hemodialysis, were not. The median observation period of patients who achieved curative resection was 25.9 months (range 0.8—112.7 months) and the 3-year overall survival rate was 92.5 %. Conclusions: Estimated GFR is a significant independent predictive factor of post-ESD bleeding in patients with CKD. © Georg Thieme Verlag KG 2015-02 2014-10-29 /pmc/articles/PMC4423257/ /pubmed/26134770 http://dx.doi.org/10.1055/s-0034-1390762 Text en © Thieme Medical Publishers
spellingShingle Article
Yoshioka, Teppei
Nishida, Tsutomu
Tsujii, Masahiko
Kato, Motohiko
Hayashi, Yoshito
Komori, Masato
Yoshihara, Harumasa
Nakamura, Takeshi
Egawa, Satoshi
Yoshio, Toshiyuki
Yamada, Takuya
Yabuta, Takamasa
Yamamoto, Katsumi
Kinoshita, Kazuo
Kawai, Naoki
Ogiyama, Hideharu
Nishihara, Akihiro
Michida, Tomoki
Iijima, Hideki
Shintani, Ayumi
Takehara, Tetsuo
Renal dysfunction is an independent risk factor for bleeding after gastric ESD
title Renal dysfunction is an independent risk factor for bleeding after gastric ESD
title_full Renal dysfunction is an independent risk factor for bleeding after gastric ESD
title_fullStr Renal dysfunction is an independent risk factor for bleeding after gastric ESD
title_full_unstemmed Renal dysfunction is an independent risk factor for bleeding after gastric ESD
title_short Renal dysfunction is an independent risk factor for bleeding after gastric ESD
title_sort renal dysfunction is an independent risk factor for bleeding after gastric esd
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4423257/
https://www.ncbi.nlm.nih.gov/pubmed/26134770
http://dx.doi.org/10.1055/s-0034-1390762
work_keys_str_mv AT yoshiokateppei renaldysfunctionisanindependentriskfactorforbleedingaftergastricesd
AT nishidatsutomu renaldysfunctionisanindependentriskfactorforbleedingaftergastricesd
AT tsujiimasahiko renaldysfunctionisanindependentriskfactorforbleedingaftergastricesd
AT katomotohiko renaldysfunctionisanindependentriskfactorforbleedingaftergastricesd
AT hayashiyoshito renaldysfunctionisanindependentriskfactorforbleedingaftergastricesd
AT komorimasato renaldysfunctionisanindependentriskfactorforbleedingaftergastricesd
AT yoshiharaharumasa renaldysfunctionisanindependentriskfactorforbleedingaftergastricesd
AT nakamuratakeshi renaldysfunctionisanindependentriskfactorforbleedingaftergastricesd
AT egawasatoshi renaldysfunctionisanindependentriskfactorforbleedingaftergastricesd
AT yoshiotoshiyuki renaldysfunctionisanindependentriskfactorforbleedingaftergastricesd
AT yamadatakuya renaldysfunctionisanindependentriskfactorforbleedingaftergastricesd
AT yabutatakamasa renaldysfunctionisanindependentriskfactorforbleedingaftergastricesd
AT yamamotokatsumi renaldysfunctionisanindependentriskfactorforbleedingaftergastricesd
AT kinoshitakazuo renaldysfunctionisanindependentriskfactorforbleedingaftergastricesd
AT kawainaoki renaldysfunctionisanindependentriskfactorforbleedingaftergastricesd
AT ogiyamahideharu renaldysfunctionisanindependentriskfactorforbleedingaftergastricesd
AT nishiharaakihiro renaldysfunctionisanindependentriskfactorforbleedingaftergastricesd
AT michidatomoki renaldysfunctionisanindependentriskfactorforbleedingaftergastricesd
AT iijimahideki renaldysfunctionisanindependentriskfactorforbleedingaftergastricesd
AT shintaniayumi renaldysfunctionisanindependentriskfactorforbleedingaftergastricesd
AT takeharatetsuo renaldysfunctionisanindependentriskfactorforbleedingaftergastricesd