Surgical Treatment for Encapsulating Peritoneal Sclerosis: 24 Years’ Experience

Kawanishi, Hideki; Banshodani, Masataka; Yamashita, Masahiro; Shintaku, Sadanori; Dohi, Kiyohiko

doi:10.3747/pdi.2018.00042

Cited by 28 publications

(29 citation statements)

References 27 publications

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“…Abdominal lavage and removal of intraperitoneal calcifications may help to combat infection. 8 The patient described in this case was submitted to a thorough debridement of excess fibrous tissue encapsulating small bowel loops and parietal and visceral peritoneum. Along with surgery, dietary support is of crucial importance and must be started early on.…”

Section: Discussionmentioning

confidence: 99%

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Encapsulating Peritoneal Sclerosis in a kidney transplant recipient - Case Report

et al. 2020

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Encapsulating Peritoneal Sclerosis (EPS) is a severe and rare condition frequently associated with peritoneal dialysis, characterized by bowel obstruction, with lethal consequences in 20% of the patients. The disease presents as a mass of fibrous tissue encapsulating visceral organs that may potentially compromise digestive tract function. This report describes the case of a patient under peritoneal dialysis (PD) due to chronic kidney disease secondary to focal segmental glomerulosclerosis diagnosed with EPS. The patient had undergone two living-donor kidney transplant procedures. Surgical techniques and clinical measures employed to unravel bowel obstruction are described, which have been shown to ameliorate EPS secondary complications. Parenteral nutrition has significantly contributed to afford adequate nutrition, improving tissue healing as well as serum protein levels, vitamins and electrolytes. Therapy with tamoxifen and sodium thiosulfate effectively delayed the development of EPS.

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Section: Discussionmentioning

confidence: 99%

“…Most of the few reports published in the literature about surgery for EPS have cited enterectomy, lysis of bowel adhesions, or peritonectomy. 8 …”

Section: Introductionmentioning

confidence: 99%

Encapsulating Peritoneal Sclerosis in a kidney transplant recipient - Case Report

et al. 2020

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“…The presence or absence of peritoneal calcification may be important factors for determining the indication for surgical treatment is necessary [93]. On the other hand, a large adhesiolysis may induce further trauma and inflammation, potentially aggravation EPS and creating additional adhesions and constriction [139]. Surgery can reverse the bowel obstruction but relapses may occur.…”

Section: Other Therapiesmentioning

confidence: 99%

“…At present, there is not sufficient data supporting this notion. Surgical measures should be taken with caution and performed by experienced teams [139].…”

Section: Other Therapiesmentioning

confidence: 99%

Encapsulating Peritoneal Sclerosis: Pathophysiology and Current Treatment Options

Jagirdar

Bozikas

Zarogiannis

et al. 2019

IJMS

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Encapsulating peritoneal sclerosis (EPS) is a life-threatening complication of long-term peritoneal dialysis (PD), which may even occur after patients have switched to hemodialysis (HD) or undergone kidney transplantation. The incidence of EPS varies across the globe and increases with PD vintage. Causative factors are the chronic exposure to bioincompatible PD solutions, which cause long-term modifications of the peritoneum, a high peritoneal transporter status involving high glucose concentrations, peritonitis episodes, and smoldering peritoneal inflammation. Additional potential causes are predisposing genetic factors and some medications. Clinical symptoms comprise signs of intestinal obstruction and a high peritoneal transporter status with incipient ultrafiltration failure. In radiological, macro-, and microscopic studies, a massively fibrotic and calcified peritoneum enclosed the intestine and parietal wall in such cases. Empirical treatments commonly used are corticosteroids and tamoxifen, which has fibrinolytic properties. Immunosuppressants like azathioprine, mycophenolate mofetil, or mTOR inhibitors may also help with reducing inflammation, fibrin deposition, and collagen synthesis and maturation. In animal studies, N-acetylcysteine, colchicine, rosiglitazone, thalidomide, and renin-angiotensin system (RAS) inhibitors yielded promising results. Surgical treatment has mainly been performed in severe cases of intestinal obstruction, with varying results. Mortality rates are still 25–55% in adults and about 14% in children. To reduce the incidence of EPS and improve the outcome of this devastating complication of chronic PD, vigorous consideration of the risk factors, early diagnosis, and timely discontinuation of PD and therapeutic interventions are mandatory, even though these are merely based on empirical evidence.

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“…• The two-hit theory: The hypothesis of a two-hit theory, now generally accepted, proposes that two causative factors are required for the onset of EPS [39].…”

Section: Theories On the Pathogenesis Of Epsmentioning

confidence: 99%

Encapsulating Peritoneal Sclerosis: Case report and Current Status

Issad¹

2017

Arch Clin Nephrol

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Encapsulating peritoneal sclerosis (EPS), is a rare but devastating complication of long-term peritoneal dialysis (PD) with a high mortality rate. The incidence is between 0.5 and 3.3%, decreasing with time. EPS is defi ned as a clinical syndrome with major signs of gastrointestinal obstruction, infl ammatory parameters, radiological and macroscopic changes. Duration of treatment and cessation of PD are the main risk for development of EPS: about 75% of EPS occurred in patients transferred on hemodialysis or in the two years after kidney transplantation. Morphological alterations are disappearance of mesothelial layer, sub-mesothelial fi brosis, interstitial sclerosis and vasculopathy, ultrafi ltration failure, fast transport status of the peritoneal membrane, and loss of sodium sieving are the most predicting functional abnormalities. Some biomarkers could be found in the peritoneal effl uent. The pathophysiology is probably a consequence of a multiple-hit process in which expression of growth factors and cytokines play a role. Medical strategies (corticosteroids, immunosuppressive drugs, tamoxifen) in association with parenteral nutrition and/or surgery (enterolysis) are discussed. Prevention is the use of physiological peritoneal solutions, icodextrine instead of high glucose concentration solution, and peritoneal lavage after peritoneal dialysis cessation for any reason.

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Surgical Treatment for Encapsulating Peritoneal Sclerosis: 24 Years’ Experience

Abstract: Excellent outcomes for EPS are achieved with surgery. The degree of peritoneal deterioration affected the clinical outcomes. Currently, EPS is no longer recognized as a fatal complication.

Cited by 28 publications

References 27 publications

Encapsulating Peritoneal Sclerosis in a kidney transplant recipient - Case Report

Encapsulating Peritoneal Sclerosis in a kidney transplant recipient - Case Report

Encapsulating Peritoneal Sclerosis: Pathophysiology and Current Treatment Options

Encapsulating Peritoneal Sclerosis: Case report and Current Status

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