Endoscopy indications in patients with chronic kidney diseases: A single-center experience in Libya

Abstract

Background and Aim: Gastrointestinal (GI) symptoms are common in patients with chronic kidney disease (CKD), and upper GI endoscopy is a diagnostic tool for GI manifestations in this group of patients, but it is not always indicated. The aim of this study was to investigate the necessity of upper GI endoscopy in CKD and end-stage renal disease (ESRD) on regular hemodialysis patients presented to emergency department (ED) with upper GI symptoms. Materials and Methods: Totally 90 CKD patients presented to ED with acute upper GI symptoms to at Tripoli Central Hospital were enrolled in this study. They were 43 females (87.8%) and 47 males (52.2%), age mean (48.9 ± 0.13). They were divided into three groups. Group A: Patients had upper GI endoscopy at presentation and after 3 days. Group B: Patients refused endoscopy at presentation, but they agreed to do it after 3 days of admission. Group C: Patients refused endoscopy at presentation and after 3 days. At ED, patients had clinical assessment, laboratory tests, and abdominal ultrasound before endoscopy. Results: Hematemesis and vomiting were the most common symptoms. Endoscopy findings at presentation in Group A were erosive gastritis in 19 patients (60.3%), erosive esophagitis in 3 patients (10%), superficial esophagitis in 7 patients (23.3%), and duodenal ulcer in 1 patient (3.3%). Repeated endoscopy after 3 days of admission revealed normal mucosal findings in 24 patients (80%) and remarkable improvement of mucosa in the rest of patients. Group B patients (30 patients) had 3 days of proton pump inhibitor therapy at medical ward and/or medical intensive care unit. Endoscopy findings after 3 days of admission revealed normal results in 29 patients (96.7%) and superficial gastritis in 1 patient (3.3%). Conclusion: Urgent endoscopy is not always needed in CKD and ESRD on hemodialysis patients with acute upper GI symptoms who presented to ED. Most of these symptoms can be managed medically, and urgent endoscopy should be deserved to patients with severe GI complications.