Endoscopic treatments of gastric mucosal lesions are not riskier in patients with chronic renal failure or liver cirrhosis.
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.
Department of Internal Medicine, Institute of Gastroenterology and Hepatology, Keimyung University School of Medicine, 194 Dong San-dong, Jung-gu, Daegu, 700-712, South Korea.
Young Lan
YL
Kwon
Eun Soo
ES
Kim
Kyung In
KI
Lee
Yong Jin
YJ
Kim
Chang Wook
CW
Park
Yun Jung
YJ
Kim
Hye Jin
HJ
Seo
Kwang Bum
KB
Cho
Kyung Sik
KS
Park
Byoung Kuk
BK
Jang
Woo Jin
WJ
Chung
Jae Seok
JS
Hwang
D000230:Adenocarcinoma / Q000453:epidemiology* / Q000601:surgery*; D000368:Aged; D015897:Comorbidity; D004210:Dissection / Q000379:methods; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000601:surgery*; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000453:epidemiology*; D008875:Middle Aged; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D016896:Treatment Outcome