Outcomes of the surgical management of encapsulating peritoneal sclerosis: A case series from a single center in Korea
Jung-Hwa Ryu1 , Kil-Yong Lee2 , Tai Yeon Koo1 , Dong Ki Kim3 , Kook-Hwan Oh3 , Jaeseok Yang1,2 , Kyu Joo Park2
1Transplantation Center, Seoul National University Hospital, Seoul, Republic of Korea
2Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea
3Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
Correspondence to: Jaeseok Yang
Transplantation Center, Department of Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea. E-mail: jcyjs@snu.ac.kr

Edited by Cheol Whee Park, The Catholic University of Korea, Seoul, Republic of Korea
Received: April 18, 2019; Revised: August 21, 2019; Accepted: September 4, 2019; Published online: October 23, 2019.
© The Korean Society of Nephrology. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Encapsulating peritoneal sclerosis (EPS) is a rare but near-fatal complication of peritoneal dialysis (PD). Despite the high mortality rate of EPS, the surgical treatment strategy of severe EPS is yet to be established.
Methods: We retrospectively analyzed outcomes of patients with EPS who underwent enterolysis for intractable EPS at Seoul National University Hospital between 2001 and 2018. EPS was diagnosed based on the clinical symptoms and radiological findings of abdominal computed tomography (CT). CT scans were scored according to an EPS scoring system that assessed peritoneal thickening and calcification as well as bowel thickening, tethering, loculation, and dilatation.
Results: Thirteen patients (nine males and four females; age, 48 [29–63] years) underwent enterolysis for severe EPS. PD duration (11 [6–21] years) was not associated with survival. Two patients were newly diagnosed with EPS following kidney transplantation. Five patients died of infectious complications immediately after the surgery. Eight patients survived after the first surgery; however, five of them underwent reoperation but died of persistent infection, fistula formation, or adhesive bowel obstruction. Four young (< 60 years) male patients with relatively low CT scan scores (< 13) survived for > 2 years after the first surgery. Median survival duration from EPS diagnosis was 22 (1.3–184) months and that from the first surgery was 9 (0.3–153) months.
Conclusion: The high mortality rate of EPS suggests the importance of appropriate surgical intervention in young symptomatic male EPS patients with relatively low CT scan scores.
Keywords: Encapsulating peritoneal sclerosis, Mortality, Peritoneal dialysis, Surgery


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