Authors (including presenting author) :
Cheung TW(1), Sun C(1), Suen TL(1), Huang HF(1), Tam A(1), Tai LF(1), Leung CM(1)
Affiliation :
(1)Department of Medicine, Pamela Youde Nethersole Eastern Hospital
Keyword 2: :
Peritoneal dialysis
Keyword 3: :
Peritoneal dialysis related peritonitis
Introduction :
Colonoscopy is a common endoscopic procedure performed in clinical practice. In our locality, peritoneal dialysis is the predominant renal replacement therapy for patients with end-stage renal failure. Peritoneal dialysis (PD) patients undergoing colonoscopy are reported to have increased risk of post-colonoscopy peritoneal dialysis-related peritonitis (PPDP). However, local data on its incidence, risk factors, and outcomes are limited.
Objectives :
This study aims to evaluate the clinical background characteristics and outcomes of PD patients who underwent colonoscopy, and identify risk factors associated with PPDP.
Methodology :
This is a single-center study that retrospectively reviewed PD patients undergoing colonoscopy from January 2009 to December 2024. PPDP was defined as peritoneal dialysis-related peritonitis occurring within one week following colonoscopy. Patients' background characteristics colonoscopy findings, and microbiology results of the peritonitis episodes were reviewed.
Result & Outcome :
A total of 152 colonoscopy episodes were reviewed, with 19 episodes of PPDP (8%) identified. PPDP was strongly associated with endoscopic procedural factors. Polypectomy was significantly associated with PPDP (p< 0.001). All PPDP cases involved submucosal injection and hot snare polypectomy (p< 0.001). The PPDP group had significantly more polyps removed (p< 0.001). Polyps measuring 10mm or larger were more common in the PPDP group (p=0.03), while smaller polyps (< 10mm) showed no significant differences (p=0.22). Other polypectomy techniques, including hot forceps (p=0.13), cold snare (p=1.00), and cold forceps (p=1.00), showed no significant differences. More than half of PPDP cases (53%) presented within 24 hours post-colonoscopy. Multidrug-resistant organisms (MDROs) accounted for 68% of PPDP, predominantly extended-spectrum beta-lactamase–producing Escherichia coli. Most cases required escalation of antibiotics due to resistant organisms (69%). Patients with PPDP had a significantly longer hospital length of stay compared with those without PPDP (median 7 days vs. 1 day, p< 0.001). Two patients required Tenckhoff catheter removal and conversion to hemodialysis. In conclusion, PPDP is a potentially serious complication for PD patients undergoing colonoscopy. The study findings suggest the cautious use of polypectomy techniques including submucosal injection and hot snare polypectomy, and enhanced post-colonoscopy monitoring may improve clinical safety and outcome in these patients.
