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Jin BC, Kim DH, Seo GS, Kim SW, Oh HH, Song HY, Kim SJ, Joo YE, Lee J, Kim HS. The Outcomes of Colorectal Endoscopic Submucosal Dissection in Patients with Chronic Kidney Disease: A Honam Association for the Study of Intestinal Disease (HASID) Multicenter Study. Diagnostics (Basel) 2024; 14:1459. [PMID: 39001348 PMCID: PMC11240901 DOI: 10.3390/diagnostics14131459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/01/2024] [Accepted: 07/01/2024] [Indexed: 07/16/2024] Open
Abstract
Colorectal neoplasms are prevalent in patients with chronic kidney disease (CKD); however, the safety and efficacy of colorectal endoscopic submucosal dissection (ESD) are not well understood. This retrospective analysis included ESD procedures performed in 1266 patients with CKD across five tertiary medical institutions from January 2015 to December 2020. Patients were categorized based on their estimated glomerular filtration rate (eGFR), which ranged from CKD1 to CKD5 (including those on dialysis). We found that en bloc resection rates remained high across all CKD stages, affirming the procedural efficacy of ESD. Notably, the prevalence of cardiovascular comorbidities, such as ischemic heart disease and diabetes mellitus, significantly increased with an advancing CKD stage, with a corresponding increase in the Charlson Comorbidity Index, highlighting the complexity of managing these patients. Despite these challenges, the complete resection rate was lower in the CKD5 group (50%) than in the CKD1 group (83.4%); however, procedural complications, such as perforation and bleeding, did not significantly differ among the groups. The predictive models for complete resection and major complications showed no significant changes with a decreasing eGFR. These findings underscore that ESD is a feasible and safe treatment for colorectal neoplasms in patients with CKD, successfully balancing the inherent procedural risks with clinical benefits.
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Affiliation(s)
- Byung Chul Jin
- Department of Internal Medicine, Research Institute of Clinical Medicine, Biomedical Research Institute, Jeonbuk National University Medical School, Jeonbuk National University, Jeonju 54907, Republic of Korea;
| | - Dong Hyun Kim
- Department of Internal Medicine, Medical School, Chonnam National University, Gwangju 61469, Republic of Korea; (D.H.K.); (H.-H.O.); (Y.-E.J.); (H.-S.K.)
| | - Geom-Seog Seo
- Department of Internal Medicine, Digestive Diseases Research Institute, School of Medicine, Wonkwang University, Iksan 54538, Republic of Korea;
| | - Sang-Wook Kim
- Department of Internal Medicine, Research Institute of Clinical Medicine, Biomedical Research Institute, Jeonbuk National University Medical School, Jeonbuk National University, Jeonju 54907, Republic of Korea;
| | - Hyung-Hoon Oh
- Department of Internal Medicine, Medical School, Chonnam National University, Gwangju 61469, Republic of Korea; (D.H.K.); (H.-H.O.); (Y.-E.J.); (H.-S.K.)
| | - Hyo-Yeop Song
- Department of Internal Medicine, Digestive Diseases Research Institute, School of Medicine, Wonkwang University, Iksan 54538, Republic of Korea;
| | - Seong-Jung Kim
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju 61452, Republic of Korea; (S.-J.K.); (J.L.)
| | - Young-Eun Joo
- Department of Internal Medicine, Medical School, Chonnam National University, Gwangju 61469, Republic of Korea; (D.H.K.); (H.-H.O.); (Y.-E.J.); (H.-S.K.)
| | - Jun Lee
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju 61452, Republic of Korea; (S.-J.K.); (J.L.)
| | - Hyun-Soo Kim
- Department of Internal Medicine, Medical School, Chonnam National University, Gwangju 61469, Republic of Korea; (D.H.K.); (H.-H.O.); (Y.-E.J.); (H.-S.K.)
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Yu JP, Yang SP, Ruan RW, Chen SS, Li YD, Lou HB, Wang S. Factors associated with non-lifting of colorectal mucosal lesions. Scand J Gastroenterol 2023; 58:429-434. [PMID: 36256445 DOI: 10.1080/00365521.2022.2133971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) is an effective treatment for colorectal tumors. However, lesions that cannot be lifted after submucosal injection are not indication for ESD. This is because the procedure is difficult, and the lesions are often considered as tumor invasion or submucosal fibrosis. The aims of this study are to evaluate the efficacy and safety of ESD for non-lifting lesions and to analyze the causes of non-lifting phenomenon. METHODS This retrospective study included 29 patients with non-lifting colon lesions resected by ESD from February 2018 to September 2021. Cases were observed for demographics, endoscopic findings, treatment outcomes, adverse events and endoscopic follow-up. We studied the pathological features of lesions to explore the reasons for non-lifting. RESULTS Among 29 cases of non-lifting lesions, 20 lesions (69.0%) were 30 mm in diameter or larger. Most of lesions (96.6%) were non-lifting in center, and only one lesions (3.4%) had non-lifting of one side. The en bloc and curative resection rates of ESD were 100 and 86.2%, respectively. There was one (3.4%) delayed bleeding, no perforations and other complications. No tumor recurrence occurred during the follow-up period. For pathological features, 16 (55.2%) non-lifting lesions had submucosal fibrosis and only 4 cases (13.8%) had deep submucosal invasion. There were 9 cases (31.0%) of non-lifting lesions due to musculo-fibrous of muscularis propria anomaly (MMPA). CONCLUSION MMPA is another reason for non-lifting signs besides invasive carcinomas and submucosal fibrosis. ESD should be considered in patients with large non-lifting adenoma instead of surgery.
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Affiliation(s)
- Jiang-Ping Yu
- Department of Endoscopy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Shao-Peng Yang
- Department of Endoscopy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Rong-Wei Ruan
- Department of Endoscopy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Sheng-Sen Chen
- Department of Endoscopy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Yan-Dong Li
- Department of Endoscopy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Hai-Bin Lou
- Department of Endoscopy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Shi Wang
- Department of Endoscopy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
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