This article appears in the following NDT Plus issue: Parathyroid Intervention - Current themes and future perspectives [View the issue table of contents]
Effects of percutaneous ethanol injection therapy on subsequent surgical parathyroidectomy
Kidney Center, Toranomon Hospital, Tokyo, Japan
Correspondence: Michio Nakamura, Kidney Center, Toranomon Hospital, 105-8470, 2-2-2 Toranomon, Minato-ku, Tokyo, Japan. E-mail: mnakamura{at}toranomon.gr.jp
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Abstract |
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Background. Renal hyperparathyroidism (RHPT) is a serious complication of long-term dialysis treatment. Two intervention methods can be administered to treat RHPT, namely percutaneous ethanol injection therapy (PEIT) and a parathyroidectomy (PTx). PEIT is associated with a significant adverse event, adhesion formation. This study was performed to investigate the effect of PEIT on subsequent PTx.
Methods. A total of 80 subjects were included in the study. The patients had a diagnosis of RHPT for which surgery was indicated. They were divided according to whether they underwent PEIT (PEIT group) or not (non-PEIT group). The outcomes of PTx following PEIT were evaluated.
Results. There were 19 patients in the PEIT group and 61 in the non-PEIT group. The operation time was significantly longer in the PEIT group but no significant differences in the amount of bleeding or frequency of recurrent nerve paralysis were observed. The intact PTH levels immediately following surgery were slightly higher in the PEIT group. The postoperative intact PTH levels were found to be significantly higher in those who received two or more courses of PEIT. The number of patients with an intact PTH level >60 pg/ml on postoperative Day 1 was significantly higher in the PEIT group.
Conclusions. These findings suggested that PEIT prior to PTx can affect the subsequent surgical outcome due to associated adhesions and dissemination. For patients with a possibility of either a decreased efficacy or a lack of efficacy for PEIT, it is therefore important to consider PTx from the very beginning of the treatment.
Key Words: haemodialysis • laryngeal recurrent nerve paralysis • parathyroidectomy • percutaneous ethanol injection therapy (PEIT) • renal hyperparathyroidism
Received for publication February 29, 2008. Accepted for publication March 7, 2008.