Feasibility of endoscopic submucosal dissection for patients with chronic renal failure on hemodialysis

Endoscopic submucosal dissection (ESD) is expected as a curative method for node-negative gastrointestinal cancers. Little is known about ESD for patients with end-stage chronic renal failure (CRF) on hemodialysis. We aimed to evaluate the efficacy and safety of ESD for patients with CRF on hemodialysis.

Ten consecutive patients with 12 lesions who underwent ESD (stomach, seven; colorectum, three) between March 2002 and August 2007 were retrospectively investigated in terms of the technical feasibility and complications.

All the lesions were resected in a single piece and en-bloc and R0 resection rate was 100%. Histology revealed that all the lesions fulfilled the criteria of node-negative cancers. Delayed bleeding requiring blood transfusion on the day after ESD, and shunt occlusion, which necessitated a radiological intervention 7 days after ESD, occurred in one stomach case. Delayed perforation followed by emergency surgery 2 days after ESD occurred in one colorectal case.

ESD for CRF patients may be technically feasible, but substantial risks should be considered. Early detection of late-onset complications is essential with intensive medical check-up for at least 1 week in order to prevent complications from becoming severe.