Clinical Endoscopy

Bleeding after Endoscopic Resection in Patients with End-Stage Renal Disease on Dialysis: A Multicenter Propensity Score-Matched Analysis: In Kyung Yoo, Chan Gyoo Kim, Young Ju Suh, Younkyung Oh, Gwang Ho Baik, Sun Moon Kim, Young Dae Kim, Chul-Hyun Lim, Jung Won Jeon, Su Jin Hong, Byoung Wook Bang, Joon Sung Kim, Jun-Won Chung; Clin Endosc 2020;53(4):452-457. Published online October 25, 2019; DOI: https://doi.org/10.5946/ce.2019.107

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 for gastric neoplasia, were enrolled. A total of 47 ESRDpatients 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 ER method. Matching was performed using an optimal matching algorithm. For the matched data, clustered comparisons were performed using the generalized estimating equation method. Medical records were retrospectively reviewed. Frequency and outcomes of post-ER bleeding were evaluated.
Results
Bleeding was more frequent in the ESRD with dialysis group than in the non-ESRD group. ESRD with dialysis conferred a significant risk of post-ER bleeding (odds ratio, 6.1; 95% confidence interval, 2.7–13.6; p<0.0001). All post-ER bleeding events were controlled 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 endoscopically without sequelae. Concern about bleeding should not stop endoscopists from performing ER in ESRD patients on dialysis.

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Endoscopic Papillary Large Balloon Dilatation for Large Biliary Stones in a Hemodialysis Patient: A Case Report: Seung Hyun Cho, M.D., Dong Ki Lee, M.D., Byung Jun Lee, M.D.,Hyun Chul Lim, M.D. and Chan Ik Park, M.D.; Korean J Gastrointest Endosc 2007;35(6):451-456. Published online December 30, 2007

Abstract PDF: In retrieving bile duct stones, full-endoscopic sphincterotomy (EST) with endoscopic mechanical lithotripsy (EML) is considered as a traditional method, and balloon dilation of the papillary sphincter has also been used. Recent studies have reported that mid-EST and endoscopic papillary large balloon dilatation (EPLBD) was as useful as full-EST with EML, without serious complications. In patients with coagulopathy, such as end-stage renal disease, even a small incision of the sphincter could cause profuse bleeding. In such patients, balloon dilation of the sphincter is a preferred technique over EST. A prior Billroth-II operation renders EST more difficult and increases the risk of a complication. In these patients, the use of EPBD is also preferred as well. We report a case of successfully retrieving large bile duct stones by EPLBD without EST, in a patient who had a prior Billroth-II operation, and is undergoing hemodialysis. The patient is free of complications, such as bleeding or acute pancreatitis. (Korean J Gastrointest Endosc 2007;35:451-455)

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대량출혈을 동반한 상행결장 허혈성 대장염 1 예: Korean J Gastrointest Endosc 2001;23(5):401-401. Published online November 30, 2000

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