PDF(Pubmed)
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.
摘要：
结直肠肿瘤在慢性肾脏病(CKD)患者中普遍存在;然而,结直肠内镜黏膜下剥离术(ESD)的安全性和有效性尚不清楚.这项回顾性分析包括2015年1月至2020年12月在5家三级医疗机构的1266例CKD患者中进行的ESD程序。根据估计的肾小球滤过率（eGFR）对患者进行分类，范围从CKD1到CKD5（包括透析患者）。我们发现所有CKD阶段的整体切除率仍然很高，确认ESD的程序有效性。值得注意的是,心血管合并症的患病率，比如缺血性心脏病和糖尿病，随着CKD阶段的推进显着增加，随着Charlson合并症指数的相应增加，强调管理这些患者的复杂性。尽管面临这些挑战,CKD5组(50%)的完全切除率低于CKD1组(83.4%);手术并发症,如穿孔和出血，各组间无显著差异。完全切除和主要并发症的预测模型显示，随着eGFR的降低，没有显着变化。这些发现强调ESD是CKD患者结直肠肿瘤的可行且安全的治疗方法。成功平衡固有的手术风险与临床利益。
