Tamoxifen Therapy for Encapsulating Peritoneal Sclerosis: Mechanism of Action and Update on Clinical Experiences

Guest, Steven

doi:10.1177/089686080902900304

Cited by 45 publications

(39 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The main advantage of tamoxifen is that it has no immunosuppressive effect. 24 Medical management has a very limited role in nonperitoneal dialysis EPS patients. Cases related to long term beta blocker usage can be managed by cessation of beta blocker therapy.…”

Section: Tamoxifenmentioning

confidence: 99%

Abdominal cocoon: a surgical challenge

Vagholkar¹,

Doctor-Ganju²

2018

Int Surg J

View full text Add to dashboard Cite

Encapsulating peritoneal sclerosis (EPS) or sclerosing peritonitis best described as abdominal cocoon is a complex syndrome characterized by formation of a thick fibrocollagenous membrane that totally encloses the small intestinal loops. The etiology is varied and multifactorial. This complex disease is usually associated with continuous peritoneal dialysis (PD), tuberculosis, post renal transplant, or with long term use of beta blockers. A few cases may even be idiopathic in origin. The pathogenesis is attributed to conversion of epithelial cells from the peritoneal lining to mesenchymal cells leading to a formation of a thick membrane. The clinical features range from abdominal pain due to altered gut motility to frank features suggestive of intestinal obstruction. Making a pre-operative diagnosis is the biggest challenge in abdominal cocoon. However computerized tomography provides enough information to arrive at a diagnosis. Surgical intervention continues to remain the final option in an unremitting intestinal obstruction despite the role of conservative therapy using drugs proposed for treatment. The focus of management is early diagnosis and treatment in order to halt the progression to a frank cocoon. The paper reviews the etiopathogenesis and management of this intricate condition.

show abstract

Section: Tamoxifenmentioning

confidence: 99%

Abdominal cocoon: a surgical challenge

Vagholkar¹,

Doctor-Ganju²

2018

Int Surg J

View full text Add to dashboard Cite

show abstract

“…The therapeutic potential of tamoxifen therapy is confirmed in a significant proportion of reported cases, that showed improvement of the intestinal function and a decrease in inflammation and fibrosis. 15,16 Tamoxifen may have beneficial effects in the management of EPS but caution is warranted and more studies are needed to confirm its adverse effects. 17 Surgical treatments for EPS are reported in larger case series, but recurrence rates are high.…”

Section: Discussionmentioning

confidence: 99%

A combination of corticosteroid, sirolimus, and intradialytic parenteral nutrition in encapsulating peritoneal sclerosis: Case report and literature review

Brabo

Reis

Barretti

et al. 2016

Hemodialysis International

View full text Add to dashboard Cite

Encapsulating peritoneal sclerosis (EPS) is a rare complication of peritoneal dialysis that carries a high morbidity and mortality. Although its pathogenesis is still not clear, the "two hit theory" suggests that long term deterioration of the peritoneum combined with intraperitoneal inflammation is needed in the pathogenesis of EPS. To date, there is no proven effective therapy with an absence of randomized controlled trials. Individual case reports and small case series have reported on the use of tamoxifen and corticosteroids for medical management of EPS. Here, we present the first case of EPS treated successfully with a combination of sirolimus, low dose corticosteroid and intradialytic parenteral nutrition. A critical review of the relevant literature on this subject is also presented to determine the best approach.

show abstract

“…However, it is not possible to determine which of these treatments has had the greatest benefit, as no uniformly successful therapy for EPS exists at present. Tamoxifen is the most studied medical treatment, but to our knowledge, its use has only been reported in small case series of non‐transplant patients, and only in case studies of EPS post renal transplantation . Surgical treatments for EPS are reported in larger case series, but recurrence rates are high .…”

Section: Discussionmentioning

confidence: 99%

“…Tamoxifen is the most studied medical treatment, but to our knowledge, its use has only been reported in small case series of non‐transplant patients, and only in case studies of EPS post renal transplantation . Surgical treatments for EPS are reported in larger case series, but recurrence rates are high . The immunosuppressive and antiproliferative properties of everolimus give it a theoretical role for use in the disease.…”

Section: Discussionmentioning

confidence: 99%

A role for everolimus in post‐transplant encapsulating peritoneal sclerosis: First case report

et al. 2014

View full text Add to dashboard Cite

ABSTRACT:Encapsulating peritoneal sclerosis (EPS) is a rare complication of peritoneal dialysis (PD) that carries a high morbidity and mortality. The 'two hit theory' suggests that long term deterioration of the peritoneum combined with intraperitoneal inflammation is needed in the pathogenesis of EPS. For unclear reasons, post transplantation EPS is being increasingly reported in patients previously on PD. To date, there is no proven effective therapy with an absence of randomised controlled trials. Individual case reports and small case series have reported on the use of tamoxifen and corticosteroids for medical management of EPS. The use of everolimus has been reported in a single case, and never in the setting of renal transplantation. Here, we present the first case of post-transplant encapsulating peritoneal sclerosis treated successfully with a combination of everolimus, tamoxifen, low dose corticosteroid and surgery. CASE REPORTA 37-year-old man of Vietnamese background presented to our hospital in March 2009 for deceased donor renal transplantation.End-stage renal failure was secondary to hepatitis C-related mesangioproliferative glomerulonephritis with cryoglobulinaemia. He had been on automated peritoneal dialysis for over 6 years with a combination of dextrose based peritoneal dialysis solutions. There had been no previous episodes of peritoneal dialysis-related peritonitis. A preceding peritoneal equilibration test showed that he was a high average transporter. In the year prior to transplant he had lost all residual renal function, and had signs of peritoneal membrane failure. At the time of being called for transplantation, he was hypertensive to 250/110 mmHg and was fluid overloaded in excess of 5 L, as a consequence of gradual ultrafiltration failure. Biochemically he was under-dialysed with a urea of 28 mmol/L and creatinine 1180 μmol/L. Hypertension had been complicated by severe left ventricular hypertrophy, diastolic dysfunction and moderate pulmonary hypertension. Other comorbidities were renal osteodystrophy and renal anaemia. Previous liver biopsies and his hepatitis C viral loads by polymerase chain reaction suggested that this disease was quiescent with no evidence of cirrhosis.The donor was a 46-year-old, brain dead man. There was a 5/6 HLA mismatch with a cold ischemic time of 15.5 hours. Serology showed cytomegalovirus donor and recipient positivity. Transplantation was planned with 'standard' induction therapy including basiliximab, methylprednisone, tacrolimus and mycophenolate mofetil. Standard prophylactic agents including valganciclovir, trimethoprim/sulfamethoxazole, pantoprazole and nystatin were also commenced. Hypertension was aggressively managed prior to transplant.The transplant surgery was complicated by donor kidney core biopsy-related haematuria and subscapular bleeding with blood pressure instability. Because of the likelihood of need for dialysis after transplant surgery, the surgeon opted to leave the Tenckoff catheter in situ. Dialysis was not required. However, re...

show abstract

Tamoxifen Therapy for Encapsulating Peritoneal Sclerosis: Mechanism of Action and Update on Clinical Experiences

Cited by 45 publications

References 29 publications

Abdominal cocoon: a surgical challenge

Abdominal cocoon: a surgical challenge

A combination of corticosteroid, sirolimus, and intradialytic parenteral nutrition in encapsulating peritoneal sclerosis: Case report and literature review

A role for everolimus in post‐transplant encapsulating peritoneal sclerosis: First case report

Contact Info

Product

Resources

About