Renal dysfunction is an independent risk factor for bleeding after gastric ESD.
Renal dysfunction is an independent risk factor for bleeding after gastric ESD.
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DOI：
10.1055/s-0034-1390762
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发表时间：
2015-02
影响因子：
2.6
通讯作者：
Takehara T
中科院分区：
文献类型：
--
作者：
Yoshioka T;Nishida T;Tsujii M;Kato M;Hayashi Y;Komori M;Yoshihara H;Nakamura T;Egawa S;Yoshio T;Yamada T;Yabuta T;Yamamoto K;Kinoshita K;Kawai N;Ogiyama H;Nishihara A;Michida T;Iijima H;Shintani A;Takehara T
背景和研究目的：全球范围内患有慢性肾脏病（CKD）的患者数量不断增加，并且胃癌有时与CKD同时发生。然而，内镜粘膜下剥离术（ESD）治疗 CKD 患者的安全性和可行性尚不清楚。本研究的目的是阐明胃 ESD 对 CKD 患者的可行性和安全性。 患者和方法：这是一项多中心回顾性队列研究。总共有 144 名 CKD 患者在 2003 年 5 月至 2012 年 10 月期间接受了胃 ESD 治疗。根据改善肾脏病全球结果指南，患者被分为三组：第 3 阶段（估计肾小球滤过率 [eGFR]：30 – 59 mL/min）、第 4 阶段（eGFR：15 – 29 mL/min）和第 5 阶段（eGFR： < 15 mL/min）。整体切除率和治愈性切除率以及并发症被评估为短期结果。使用 Kaplan – Meier 方法分析总体生存率。 结果：总共有 92 名患者处于 3 期 CKD；第4阶段23个； 5 期患者 29 例，其中 19 例进行血液透析。整块切除率为95.8%。 4 名 5 期 CKD 患者 (13.8%)、3 名 4 期 CKD 患者 (13.0%) 和 1 名 3 期 CKD 患者 (1.1%) 观察到 ESD 后出血。所有出血均可通过内镜止血控制，但有 5 名患者需要输血。 5 期 CKD 患者中两名 (6.9%) 发生穿孔，4 期患者无穿孔 (0%)，3 期患者两名 (4.3%) 发生穿孔。 多变量泊松回归分析显示 CKD 4 期是与出血相关的关键因素，而糖尿病和 CKD 5 期（主要由接受血液透析的患者组成）则不是。实现根治性切除的患者中位观察期为25.9个月（范围0.8-112.7个月），3年总生存率为92.5 %。 结论：估计 GFR 是 CKD 患者 ESD 后出血的重要独立预测因素。
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.