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

Abstract

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. Keywords Endoscopy Chronic renal failure Liver cirrhosis Endoscopic techniques such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have been accepted worldwide as alternative surgical methods for early and superficial neoplastic lesions of the gastrointestinal (GI) tract [1–3]. These techniques have the advantages of being less invasive and more economical than conventional surgical treatment [4]. The method of ESD allows en bloc resection of larger or ulcerative lesions, reducing the risk of residual tumor [5–8]. However, complications such as bleeding and perforation have been reported during EMR or ESD procedures [1–3, 9]. ESD is associated with a longer operation time and a higher incidence of intraoperative bleeding and perforation than EMR [1]. In general, patients with chronic diseases, including chronic renal failure (CRF) or liver cirrhosis (LC), are considered high-risk candidates for invasive treatments because of a tendency to bleed and the vulnerability of tissues [10]. Although there have been several reports about clinical outcomes of open surgery for patients with CRF or LC, little investigation has been carried out regarding the feasibility of EMR or ESD in these patients [11–14]. The aim of the present study was to assess the safety, efficacy, and clinical outcomes of EMR and ESD in patients with CRF or LC.