Encapsulating peritoneal sclerosis: prevention and treatment.

Area of Science:

• Nephrology
• Gastroenterology
• Surgical Complications

Background:

• Encapsulating peritoneal sclerosis (EPS) has historically been viewed as a fatal complication of peritoneal dialysis (PD).
• EPS incidence in PD patients is 2.5%, with longer PD duration increasing risk and mortality.
• Over half of EPS cases arise after PD withdrawal, necessitating careful monitoring.

Purpose of the Study:

• To review the current understanding of encapsulating peritoneal sclerosis (EPS) in peritoneal dialysis (PD) patients.
• To highlight the risks associated with long-term PD and strategies for managing EPS.
• To emphasize that EPS is a treatable condition, not necessarily fatal.

Main Methods:

• Literature review of reported cases and treatment outcomes for EPS in PD patients.
• Analysis of risk factors, including PD duration and solutions used.
• Examination of therapeutic strategies and surgical interventions for EPS.

Main Results:

• Maintaining patients on standard PD for over 8 years significantly increases EPS risk.
• Early diagnosis and stage-appropriate treatment, including steroids, are crucial.
• Surgical intervention (laparotomy and enterolysis) can lead to a complete cure for persistent bowel obstruction.

Conclusions:

• Encapsulating peritoneal sclerosis (EPS) is a significant risk for long-term PD patients.
• While associated with risks, EPS is manageable and not inevitably fatal.
• Prompt and appropriate treatment, including steroids and surgery when indicated, improves outcomes for PD patients with EPS.