Surgical treatment for encapsulating peritoneal sclerosis.

Although encapsulating peritoneal sclerosis (EPS) is feared as a fatal complication of peritoneal dialysis (PD), several recent studies have reported that many cases of EPS can be completely cured by appropriate methods of prevention and treatment. In this study, we describe therapeutic tactics for EPS and discuss methods of prevention. To begin, appropriate management of peritonitis and use of a biocompatible dialysis fluid are important to prevent the development of EPS. After the development of EPS is confirmed, the basic therapeutic tactics should be chosen according to the disease stage. That is, immediately after onset (inflammatory stage), EPS should be initially treated by steroid administration. If steroid therapy is ineffective, the steroid dose should be decreased immediately, and followed (encapsulating stage) by management with total parenteral nutrition (TPN). If ileus symptoms remain (ileus stage), active laparotomy and total intestinal enterolysis should be performed. During surgical treatment of EPS, it is important to perform total enterolysis without damaging the capsule-covered intestine. We believe that EPS is no longer an incurable disease, and that it can be completely cured by active diagnosis and treatment.