title: C-reactive protein levels in combination with abdominal CT scans is a useful tool to predict the macroscopic appearance in late-stage EPS patients prior to surgery.
abstract: BACKGROUND
  Diagnosis of encapsulating peritoneal sclerosis (EPS) is based on clinical symptoms, radiologic findings, and macroscopic or histological criteria. Two diagnostic scores for radiologic findings in computed tomography (CT) scans of patients with EPS have been established in the past (by Tarzi et al and Vlijm et al). The macroscopic appearance of EPS has previously been separated into three types. The use of CT scan as a tool to predict different macroscopic phenotypes, leading to specific surgical techniques and different medical treatment, has not yet been investigated.
  
  
  METHODS
  We retrospectively analyzed 30 patients with late-stage EPS who underwent major surgery with peritonectomy and enterolysis. The preoperative CT scans were scored according to the two aforementioned established diagnostic CT scores. The macroscopic phenotype, surgical procedure, and laboratory values at the time of surgery were evaluated. CT findings in the different macroscopic phenotypes were analyzed.
  
  
  RESULTS
  All patients had highly predictive CT scores for EPS. The macroscopic Type III had significantly higher CT scores compared with the other macroscopic phenotypes. Patients with macroscopic Type I had significantly higher C-reactive protein values compared to EPS Type III. Operation time was significantly longer, and repeated surgery and intraoperative complications were more frequent in EPS Type I compared with EPS Type III (P<0.05). Using the CT score and CRP level, the sensitivities for prediction of EPS I and III were 78% and 87% with corresponding specificities of 67% and 93%.
  
  
  CONCLUSIONS
  Abdominal CT scans might help to identify patients with a higher risk of complications and provide important information for the surgical intervention prior to surgery.
authors: Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany.
authors: Daniel
authors: D
authors: Kitterer
authors: Division of Nephrology, University Hospital, Zurich, Switzerland.
authors: Stephan
authors: S
authors: Segerer
authors: Department of General, Visceral and Trauma Surgery, Robert-Bosch-Hospital, University of Stuttgart, Stuttgart, Germany.
authors: Wolfgang
authors: W
authors: Steurer
authors: Department of Mathematics, University of Stuttgart, Stuttgart, Germany.
authors: Juergen
authors: J
authors: Dippon
authors: Department of Radiology and Nuclear Medicine, Robert-Bosch-Hospital, Stuttgart, Germany.
authors: Angela
authors: A
authors: Geissler
authors: Department of General, Visceral and Trauma Surgery, Robert-Bosch-Hospital, University of Stuttgart, Stuttgart, Germany.
authors: Christoph
authors: C
authors: Ulmer
authors: Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany.
authors: Niko
authors: N
authors: Braun
authors: Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany.
authors: Mark Dominik
authors: MD
authors: Alscher
authors: Department of Internal Medicine, Division of Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany.
authors: Joerg
authors: J
authors: Latus
keywords: PEEL; encapsulating peritoneal sclerosis; intraoperative findings; macroscopic phenotype; medical therapy in EPS; peritoneal dialysis; peritonectomy and enterolysis