Recommendation of the Surgical Option for Treatment of Encapsulating Peritoneal Sclerosis

Abstract

Encapsulating peritoneal sclerosis (EPS) is an intestinal obstruction syndrome in which peritoneal deterioration and intraperitoneal inflammation result in intestinal adhesions, which are covered with a fibrin capsule and cause bowel obstruction. The widespread use of peritoneal dialysis (PD) has been associated with an increase in the number of patients with this life-threatening complication. For this reason, some negative comments have been made about PD therapy. However, recent clinical studies have elucidated the pathogenesis of EPS and proposed therapeutic strategies. Currently, these facts are known: EPS occurs in 2.5% of all patients (3.18/1000 patient-years). A longer duration of PD is associated with a higher incidence of EPS and a poorer prognosis, indicating the involvement of peritoneal deterioration in the development of EPS. Development of EPS involves some kind of infection. Development of EPS frequently occurs after PD withdrawal and catheter removal. Peritoneal lavage after PD withdrawal delays, but cannot prevent the development of EPS. Timely administration of steroids is effective. Surgical adhesiolysis is the optimal treatment to relieve bowel obstructions, but does not exclude the potential for re-adhesions, requiring various ingenious gastro-intestinal surgical techniques.