The Outcomes of Colorectal Endoscopic Submucosal Dissection in Patients with Chronic Kidney Disease: A Honam Association for the Study of Intestinal Disease (HASID) Multicenter Study
Byung Chul Jin,
Dong Hyun Kim,
Geom-Seog Seo,
Sang-Wook Kim,
Hyung-Hoon Oh,
Hyo-Yeop Song,
Seong-Jung Kim,
Young-Eun Joo,
Jun Lee,
Hyun-Soo Kim
Affiliations
Byung Chul Jin
Department of Internal Medicine, Research Institute of Clinical Medicine, Biomedical Research Institute, Jeonbuk National University Medical School, Jeonbuk National University, Jeonju 54907, Republic of Korea
Dong Hyun Kim
Department of Internal Medicine, Medical School, Chonnam National University, Gwangju 61469, Republic of Korea
Geom-Seog Seo
Department of Internal Medicine, Digestive Diseases Research Institute, School of Medicine, Wonkwang University, Iksan 54538, Republic of Korea
Sang-Wook Kim
Department of Internal Medicine, Research Institute of Clinical Medicine, Biomedical Research Institute, Jeonbuk National University Medical School, Jeonbuk National University, Jeonju 54907, Republic of Korea
Hyung-Hoon Oh
Department of Internal Medicine, Medical School, Chonnam National University, Gwangju 61469, Republic of Korea
Hyo-Yeop Song
Department of Internal Medicine, Digestive Diseases Research Institute, School of Medicine, Wonkwang University, Iksan 54538, Republic of Korea
Seong-Jung Kim
Department of Internal Medicine, College of Medicine, Chosun University, Gwangju 61452, Republic of Korea
Young-Eun Joo
Department of Internal Medicine, Medical School, Chonnam National University, Gwangju 61469, Republic of Korea
Jun Lee
Department of Internal Medicine, College of Medicine, Chosun University, Gwangju 61452, Republic of Korea
Hyun-Soo Kim
Department of Internal Medicine, Medical School, Chonnam National University, Gwangju 61469, Republic of Korea
Colorectal neoplasms are prevalent in patients with chronic kidney disease (CKD); however, the safety and efficacy of colorectal endoscopic submucosal dissection (ESD) are not well understood. This retrospective analysis included ESD procedures performed in 1266 patients with CKD across five tertiary medical institutions from January 2015 to December 2020. Patients were categorized based on their estimated glomerular filtration rate (eGFR), which ranged from CKD1 to CKD5 (including those on dialysis). We found that en bloc resection rates remained high across all CKD stages, affirming the procedural efficacy of ESD. Notably, the prevalence of cardiovascular comorbidities, such as ischemic heart disease and diabetes mellitus, significantly increased with an advancing CKD stage, with a corresponding increase in the Charlson Comorbidity Index, highlighting the complexity of managing these patients. Despite these challenges, the complete resection rate was lower in the CKD5 group (50%) than in the CKD1 group (83.4%); however, procedural complications, such as perforation and bleeding, did not significantly differ among the groups. The predictive models for complete resection and major complications showed no significant changes with a decreasing eGFR. These findings underscore that ESD is a feasible and safe treatment for colorectal neoplasms in patients with CKD, successfully balancing the inherent procedural risks with clinical benefits.
