Clin Endosc.  2020 Jul;53(4):452-457. 10.5946/ce.2019.107.

Bleeding after Endoscopic Resection in Patients with End-Stage Renal Disease on Dialysis: A Multicenter Propensity Score-Matched Analysis

Affiliations
  • 1Department of Gastroenterology, Cha Bundang Medical Center, Cha University College of Medicine, Seougnam, Korea
  • 2Center for Gastric Cancer, National Cancer Center, Goyang, Korea
  • 3Department of Biomedical Sciences, College of Medicine, Inha University, Incheon, Korea
  • 4Department of Internal Medicine, Hallym University College of Medicine, Chuncheon Sacred Heart Hospital, Chuncheon, Korea
  • 5Department of Internal Medicine, Konyang University Hospital, Seoul, Korea
  • 6Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Korea
  • 7Department of Internal Medicine, The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul, Korea
  • 8Department of Internal Medicine, Kyung Hee University Hospital at Gandong, College of Medicine, Seoul, Korea
  • 9Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon, Seoul, Korea
  • 10Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
  • 11Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 12Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, Korea

Abstract

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.

Keyword

Bleeding; Endoscopic resection; End-stage renal disease; Dialysis
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