Corticosteroid therapy in encapsulating peritoneal sclerosis.

Sir, Among the complications related to PD, the most serious and life-threatening one is encapsulating peritoneal sclerosis (EPS), with a reported mortality rate of more than 60% within 4 months of diagnosis w1±3x. The poor prognosis of EPS has had a negative impact on the acceptance of PD as an adequate alternative dialysis therapy to HD. This trend has been especially prominent in Japan where there are a substantial number of long-term CAPD patients. Nonetheless, a few recent reports have suggested that immunosuppression anduor corticosteroid therapy might be effective in the treatment of EPS w4,5x. Acting on these reports, the Japanese Ministry of Welfare decided in 1995 to establish a working group on the de®nition, diagnosis, and treatment of EPS w6x. The working group concluded that cortico-steroids were potentially effective in the treatment of this serious complication. Encouraged and motivated by the above-mentioned recommendation, we decided to launch corticosteroids as a ®rst line therapy for EPS in early 1997. Table 1 summarizes the clinical outcome of EPS in all patients who developed EPS between the period before and after the year of 1997. The diagnosis of EPS was made based upon the diagnostic criteria proposed by the working group w6x. Brie¯y, the de®nition of EPS is a clinical syndrome associated with ileus symptoms such as nausea, vomiting, and abdominal pain due to a mechanical bowel obstruction derived from irreversible thickening anduor sclerotic changes of the peritoneal membrane. Of the 205 patients treated for CAPD over a period of 18 years (1981±2000), 11 patients (5.5%), six before late 1996, and ®ve after early 1997, were diagnosed as having EPS. The duration of CAPD at the time of diagnosis for patients overall was 51"27 months. All patients had an episode of bacterial or fungal peritonitis at least once while they were maintained on CAPD. Before 1997, the basic therapeutic strategy for EPS had been to sustain the rest of the bowel and to apply total parental hyperalimentation (TPN). After early 1997, corticosteroid (prednisolone 0.5 mgukguday), was given orally to the patients with EPS in addition to the conventional treatment. Before late 1996, all the patients not subjected to cortico-steroid died of EPS related complications within 8 months