Surgical and medical treatments of encapsulation peritoneal sclerosis

Encapsulating peritoneal sclerosis (EPS) is a serious complication of long-term peritoneal dialysis (PD). The mortality rate for EPS has been high, primarily because of complications related to bowel obstruction. However, recent advances in clinical research have established the pathogenesis and course and a treatment strategy. To date, there is no consensus on therapy but care should be taken in trials using corticosteroid medication, and tamoxifen still remains controversial with respect to EPS treatment. The final therapeutic option for EPS is surgical enterolysis (adhesiolysis), and we have performed 239 surgical procedures in 181 patients and observed favorable outcomes. In the 1990s, Japan experienced a large number of EPS cases, and PD therapy faced a crisis. There were many negative viewpoints on treatment of EPS at the beginning, but surgery became accepted in the face of an increasing number of cases, and several other facilities introduced surgical therapy. This activity promoted the understanding of, and countermeasures against, EPS in Japan, and EPS is no longer recognized as a fatal complication.