Bleeding after Endoscopic Resection in Patients with End-Stage Renal Disease on Dialysis: A Multicenter Propensity Score-Matched Analysis
0
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background/Aims: Frequent bleeding after endoscopic resection (ER) has been reported in patients with end-stage renal disease (ESRD). We aimed to evaluate the association and clinical significance of bleeding with ER in ESRD patients on dialysis. Methods: Between February 2008 and December 2018, 7,571 patients, including 47 ESRD patients on dialysis who underwent ER forgastric neoplasia, were enrolled. A total of 47 ESRD patients on dialysis were propensity score-matched 1:10 to 470 non-ESRD patients,to adjust for between-group differences in variables such as age, sex, comorbidities, anticoagulation use, tumor characteristics, and ERmethod. Matching was performed using an optimal matching algorithm. For the matched data, clustered comparisons were performedusing the generalized estimating equation method. Medical records were retrospectively reviewed. Frequency and outcomes of post-ERbleeding were evaluated. Results: Bleeding was more frequent in the ESRD with dialysis group than in the non-ESRD group. ESRD with dialysis conferred asignificant risk of post-ER bleeding (odds ratio, 6.1; 95% confidence interval, 2.7–13.6; p<0.0001). All post-ER bleeding events werecontrolled using endoscopic hemostasis except in 1 non-ESRD case that needed surgery. Conclusions: ESRD with dialysis confers a bleeding risk after ER. However, all bleeding events could be managed endoscopicallywithout sequelae. Concern about bleeding should not stop endoscopists from performing ER in ESRD patients on dialysis.
Abstract
Background/Aims: Frequent bleeding after endoscopic resection (ER) has been reported in patients with end-stage renal disease (ESRD). We aimed to evaluate the association and clinical significance of bleeding with ER in ESRD patients on dialysis. Methods: Between February 2008 and December 2018, 7,571 patients, including 47 ESRD patients on dialysis who underwent ER forgastric neoplasia, were enrolled. A total of 47 ESRD patients on dialysis were propensity score-matched 1:10 to 470 non-ESRD patients,to adjust for between-group differences in variables such as age, sex, comorbidities, anticoagulation use, tumor characteristics, and ERmethod. Matching was performed using an optimal matching algorithm. For the matched data, clustered comparisons were performedusing the generalized estimating equation method. Medical records were retrospectively reviewed. Frequency and outcomes of post-ERbleeding were evaluated. Results: Bleeding was more frequent in the ESRD with dialysis group than in the non-ESRD group. ESRD with dialysis conferred asignificant risk of post-ER bleeding (odds ratio, 6.1; 95% confidence interval, 2.7–13.6; p<0.0001). All post-ER bleeding events werecontrolled using endoscopic hemostasis except in 1 non-ESRD case that needed surgery. Conclusions: ESRD with dialysis confers a bleeding risk after ER. However, all bleeding events could be managed endoscopicallywithout sequelae. Concern about bleeding should not stop endoscopists from performing ER in ESRD patients on dialysis.
참고문헌 (15)
- Martínez Mier G, "Morbidity and mortality in surgery for gastric cancer", Rev Gastroenterol Mex, 64, pp.78~84 (1999)
- Newman LA, "Survival among chronic renal failure patients requiring major abdominal surgery", J Am Coll Surg, 188, pp.310~314 (1999)
- Oda I, "Endoscopic submucosal dissection for early gastric cancer : technical feasibility, operation time and complications from a large consecutive series", Dig Endosc, 17, pp.54~58 (2005)
- Ono H, "Endoscopic mucosal resection for treatment of early gastric cancer", Gut, 48, pp.225~229 (2001)
- Choi YK, "Outcomes of endoscopic submucosal dissection for gastric epithelial neoplasm in chronic kidney disease patients : propensity score-matched case-control analysis", Gastric Cancer, 22, pp.164~171 (2019)
- Goto O, "Feasibility of endoscopic submucosal dissection for patients with chronic renal failure on hemodialysis", Dig Endosc, 22, pp.45~48 (2010)
- Japanese Gastric Cancer Association, "Japanese classification of gastric carcinoma-2nd English edition", Gastric Cancer, 1, pp.10~24 (1998)
- Fujishiro M, "Outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms in 200 consecutive cases", Clin Gastroenterol Hepatol, 5, pp.678~683 (2007)
- Saito Y, "Endoscopic treatment of large superficial colorectal tumors : a case series of 200 endoscopic submucosal dissections(with video)", Gastrointest Endosc, 66, pp.966~973 (2007)
- Oyama T, "Endoscopic submucosal dissection of early esophageal cancer", Clin Gastroenterol Hepatol, 3(7 Suppl 1), pp.S67~S70 (2005)
- Cherng YG, "Are non-cardiac surgeries safe for dialysis patients?-a population-based retrospective cohort study", PLoS One, 8, pp.e58942~ (2013)
- Numata N, "Clinical outcomes of endoscopic submucosal dissection for early gastric cancer in patients with chronic kidney disease", J Gastroenterol Hepatol, 28, pp.1632~1637 (2013)
- Matsumura T, "Risk factors for early and delayed post-operative bleeding after endoscopic submucosal dissection of gastric neoplasms, including patients with continued use of antithrombotic agents", BMC Gastroenterol, 14, pp.172~ (2014)
- Kaw D, "Platelet dysfunction and end-stage renal disease", Semin Dial, 19, pp.317~322 (2006)
- Akizawa T, "Nafamostat mesilate : a regional anticoagulant for hemodialysis in patients at high risk for bleeding", Nephron, 64, pp.376~381 (1993)