Encapsulating peritoneal sclerosis
SpecialtyGastroenterology

Encapsulating peritoneal sclerosis (EPS) is a chronic clinical syndrome with an insidious onset that manifests as chronic undernourishment accompanied by sporadic, acute, or subacute gastrointestinal obstruction symptoms.[1] Peritoneal dialysis is most commonly linked to encapsulating peritoneal sclerosis, especially when peritoneal dialysis is stopped.[2] The diagnosis is verified by macroscopic and/or radiological observations of intestinal encapsulation, calcification, thickening of the peritoneum, or sclerosis.[3]

Treatments that have been reported include the use of antifibrotic drugs like tamoxifen, immunosuppressant drugs like corticosteroids, nutritional support, and surgery to remove the fibrotic material.[4]

Signs and symptoms

Patients usually present with abdominal symptoms such as altered bowel habits, nausea, vomiting, anorexia, and early satiety.[5] In the early stages, these symptoms can be linked to signs of inflammation such as pyrexia and elevated CRP, and/or blood-stained ascites.[6]

Abdominal pain, fullness, overt bowel obstruction, and the presence of an abdominal mass are linked to the late stages of encapsulating peritoneal sclerosis. The intestines become gradually covered with a fibrous cocoon, which causes weight loss, malnutrition, bowel obstruction, ischemia and strangulation, infection, and death.[3]

Causes

Encapsulating peritoneal sclerosis is typically observed in patients with end-stage renal disease (ESRD) receiving long-term peritoneal dialysis therapy. Dialysis fluid's high glucose content and acidic pH cause harm to the peritoneum.[7] High glucose concentrations promote osmosis and diffusion gradients across the peritoneum, while low pH inhibits the production of harmful glucose degradation products (GDPs).[8] GDPs are created when peritoneal dialysis fluid is heated to sterilize it[9] and these result in the production of advanced glycation end products (AGEs) when glucose is present.[10] Less GDP-containing biocompatible solutions are now more frequently used, which lessens peritoneal damage.[11]

Encapsulating peritoneal sclerosis can also occur in patients who are not on peritoneal dialysis but are suffering from other illnesses like endometriosis, sarcoidosis, peritoneal and intra-abdominal cancers, chronic peritoneal ascites, intraperitoneal chemotherapy, intraperitoneal exposure to particulate matter or disinfectant, abdominal surgery, intraperitoneal infections (tuberculosis), and beta-blocker administration.[12][13]

Risk factors

The length of peritoneal dialysis treatment appears to be the primary risk factor for encapsulating peritoneal sclerosis development. The incidence of encapsulating peritoneal sclerosis rose with the length of peritoneal dialysis (PD) in an Australian survey; for patients on PD for more than 2, 5, 6, and 8 years, the rates were 1.9, 6.4, 10.8, and 19.4%, respectively.[14]

Given that there is a high incidence of encapsulating peritoneal sclerosis shortly after renal transplantation, organ transplantation seems to increase the risk of developing this condition.[15]

A frequent side effect of peritoneal dialysis, peritonitis is intricately linked to the development of encapsulating peritoneal sclerosis, with the frequency of episodes being correlated with the occurrence of encapsulating peritoneal sclerosis.[16]Encapsulating peritoneal sclerosis has been specifically linked to recurrent peritonitis caused by bacterial contamination,[17] specifically from Pseudomonas spp., Staphylococcus aureus, and specific fungal[18] organisms.[14]

Triggers

Implicated triggers include systemic rheumatologic and inflammatory disorders,[19][20] dermoid cyst rupture,[21] gynecologic neoplasms,[22][23] endometriosis,[24] organ transplantation,[25][26][27] cirrhosis,[28] mechanical or chemical intraperitoneal irritants,[29][30][31] infection,[32][33] and medications.[34][35]

Mechanism

Encapsulating peritoneal sclerosis is believed to happen in patients who have a predisposing condition if a peritoneal inflammatory process (inciting factor) takes place. This is known as the "two-hit" theory in the literature on peritoneal dialysis, according to which the non-inflammatory peritoneal sclerosis brought on by repeated dialysis treatments is the "first hit" or predisposing factor.[36] This is corroborated by the fact that during peritoneal dialysis, the cumulative incidence of encapsulating peritoneal sclerosis rises significantly over time.[37] A proinflammatory "second hit"[38] initiates a series of proangiogenic [vascular endothelial growth factor (VEGF)], proinflammatory [transforming growth factor β1 (TGFβ1), interleukin-6 (IL-6), CCN2] cytokines.[39][40] TGFβ1 stimulates peritoneal mesothelial cells to transdifferentiate into mesenchymal cells, which leads to the depletion of mesothelial cells,[41][42] increased extracellular matrix component production [collagen type 1, alpha 1 (COL1A1)], and fibrogenesis, which forms a fibrocollagenous cocoon.[43]

Diagnosis

Encapsulating peritoneal sclerosis is diagnosed clinically, supported by radiography or laparotomy, and based on a constellation of clinical findings.[5]

The non-specific laboratory results associated with encapsulating peritoneal sclerosis are linked to underlying infections, malnourishment, and inflammation.[44][36] It has been demonstrated that dialysate from patients with encapsulating peritoneal sclerosis had higher levels of inflammatory cytokines than did peritoneal dialysis controls, sometimes up to years before the condition's clinical manifestation.[45][46] Nevertheless, no biomarker has been discovered to help anticipate the onset of encapsulating peritoneal sclerosis.[47]

When distinguishing encapsulating peritoneal sclerosis from other causes of intestinal obstruction, imaging is frequently useful. Advanced encapsulating peritoneal sclerosis may be suggested by abdominal plain films with peritoneal calcification and dilated bowel loops with air-fluid levels.[5] The small bowel follow-through may be characterized by delayed transit, distension near small bowel adhesions, and a "cauliflower" appearance due to peritoneal sclerosis-encapsulated bowel loop compression. Dilated loops of bowel may appear encased in a dense fibrous membrane or matted together and tethered posteriorly on ultrasonography.[48] The appearance of a trilaminar colon wall may be due to intraperitoneal echogenic strands.[49]

As of right now, the most extensively researched and widely used imaging method for encapsulating peritoneal sclerosis diagnosis is the CT scan. Small bowel loops are frequently connected by a thickened, encircling peritoneum, which is usually accompanied by proximal bowel dilatation.[49] Increased mesenteric fat density, loculated ascites, and localized or diffuse peritoneal calcification are additional radiographic features.[50][5] Complex loculations may indicate intra-abdominal hemorrhage, but if they contain gas, there is reason to suspect sepsis or a perforation.[51] Elevated thickening or enhancement of the colon wall suggests transmural fibrosis or persistent inflammation.[49] Although it hasn't been used as much for diagnosis, magnetic resonance imaging probably produces similar results. Benefits include better bowel encasement and peritoneal thickening delineation, as well as the avoidance of ionizing radiation.[52]

The histologic results for encapsulating peritoneal sclerosis are not specific and can be confused with those for infectious peritonitis or simple peritoneal sclerosis.[53] The mesothelial cell layer is microscopically denuded by fibrin deposition, fibroblast proliferation, and fibrocollagenous deposition. When inflammation is active, there may be an infiltration of inflammatory mononuclear cells.[38] Encapsulating peritoneal sclerosis is distinguished from peritoneal sclerosis and peritonitis by the transmembrane glycoprotein podoplanin, which is present on peritoneal mesothelial cells and binds inflammatory cytokines.[54]

Classification

Based on the clinical presentation, encapsulating peritoneal sclerosis is classified into four stages:[5]

  1. Pre-encapsulating peritoneal sclerosis stage: Mild ascites, no inflammation, and no symptoms.[5]
  2. Inflammatory stage: The patient's symptoms, which include intestinal swelling and partial encapsulation of the bowel, nausea and diarrhea. There is an exudation of fibrin and mild inflammation.[5]
  3. Encapsulation: Signs of intestinal blockage brought on by the encapsulation-causing fibrous cocoon. It may be linked to inflammation, ranging from mild to severe.[5]
  4. Chronic stage of ileus: The thickening of the encapsulating fibrous cocoon causes patients to experience complete bowel obstruction. At this point, there's not much, if any, inflammation.[5]

Prevention

There is currently no known way to stop encapsulating peritoneal sclerosis from developing, despite numerous studies pointing to potential causes. There has been much discussion regarding the "expiry date" for patients receiving peritoneal dialysis because the risk of developing encapsulating peritoneal sclerosis rises with the length of the treatment.[7] Research from Japan has indicated that patients should switch to hemodialysis after the recommended 8-year safe period for continuing peritoneal dialysis.[55] Setting an expiration date, however, is not advised since it may worsen quality of life and raise the risk of complications for patients receiving hemodialysis via tunneled lines in cases where they had no symptoms while receiving peritoneal dialysis.[56]

Treatment

Treating the underlying cause of encapsulating peritoneal sclerosis is recommended whenever it is feasible. This entails switching from peritoneal dialysis to hemodialysis in the case of peritoneal dialysis.[7]

The nutritional status should be evaluated upon encapsulating peritoneal sclerosis diagnosis. Encapsulating peritoneal sclerosis cannot be effectively treated with bowel rest or total parenteral nutrition (TPN) alone; however, making sure the patient receives enough nutrition is crucial.[55] Enteral feeding is frequently not tolerated due to obstruction, necessitating TPN.[57]

Many medications have been used to target the inflammatory component of encapsulating peritoneal sclerosis such as mammalian target of rapamycin (mTOR) inhibitors,[58] cyclosporine,[59] mycophenolate mofetil,[60] colchicine,[61] corticosteroids, and azathioprine.[13][62]

For patients who have already experienced significant fibrosis, immunosuppression might not be enough. A potent anti-fibrotic agent, tamoxifen is a selective estrogen receptor modulator (SERM) that inhibits TGF-β, a crucial cytokine in the fibrosis process.[63]

Because encapsulating peritoneal sclerosis surgery is a time-consuming, dangerous, and technical procedure, it should only be performed on patients who have not responded to conservative medical therapy and, if at all possible, in facilities with prior experience performing such procedures.[64][65]

Outlook

Patients with encapsulating peritoneal sclerosis have a very high death rate, which ranges from 26% to 58%, and rises with the length of peritoneal dialysis.[15][66] Malnutrition and sepsis are the most common causes of death among those with encapsulating peritoneal sclerosis.[67]

Epidemiology

Encapsulating peritoneal sclerosis occurs between 0.5% and 7.3% of the time worldwide, but in patients receiving peritoneal dialysis for 15 years or longer, the frequency can reach 17.2%.[37] After nine years of peritoneal dialysis, the encapsulating peritoneal sclerosis risk rose to 8% in one study involving over 17,300 patients from Australia, New Zealand, and Scotland; however, when the competing risk of death was considered, the risk dropped to just 1.5%.[68]

See also

References

  1. ↑ Augustine, T.; Brown, P.W.; Davies, S.D.; Summers, A.M.; Wilkie, M.E. (January 16, 2009). "Encapsulating Peritoneal Sclerosis: Clinical Significance and Implications". Nephron Clinical Practice. S. Karger AG. 111 (2): c149–c154. doi:10.1159/000191214. ISSN 1660-2110. PMID 19147997.
  2. ↑ Pepereke, Shingai; Shah, Ankur D; Brown, Edwina A (2023). "Encapsulating peritoneal sclerosis: Your questions answered". Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis. 43 (2): 119–127. doi:10.1177/08968608221125606. ISSN 0896-8608. PMID 36189954. S2CID 252682098.
  3. 1 2 Kawaguchi, Y; Kawanishi, H; Mujais, S; Topley, N; Oreopoulos, D G (2000). "Encapsulating peritoneal sclerosis: definition, etiology, diagnosis, and treatment. International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis". Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis. 20 (4): S43–S55. doi:10.1177/089686080002004S04. PMID 11098928.
  4. ↑ Kawaguchi, Yoshindo; Saito, Akira; Kawanishi, Hideki; Nakayama, Masaaki; Miyazaki, Masanobu; Nakamoto, Hidetomo; Tranaeus, Anders (April 2005). "Recommendations on the management of encapsulating peritoneal sclerosis in Japan, 2005: diagnosis, predictive markers, treatment, and preventive measures". Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis. 25 (4): S83–S95. doi:10.1177/089686080502504S12. PMID 16300277.
  5. 1 2 3 4 5 6 7 8 9 Nakamoto, Hidetomo (April 2005). "Encapsulating peritoneal sclerosis--a clinician's approach to diagnosis and medical treatment". Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis. 25 (4): S30–S38. doi:10.1177/089686080502504S05. PMID 16300270. S2CID 18937047.
  6. ↑ Maruyama, Yukio; Nakayama, Masaaki (June 2008). "Encapsulating peritoneal sclerosis in Japan". Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis. 28 (3): S201–S204. doi:10.1177/089686080802803s37. PMID 18552256. S2CID 45478695.
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  10. ↑ Mortier, Siska; De Vriese, An S.; Van de Voorde, Johan; Schaub, Thomas P.; Passlick-Deetjen, Jutta; Lameire, Norbert H. (2002). "Hemodynamic Effects of Peritoneal Dialysis Solutions on the Rat Peritoneal Membrane". Journal of the American Society of Nephrology. Ovid Technologies (Wolters Kluwer Health). 13 (2): 480–489. doi:10.1681/asn.v132480. ISSN 1046-6673. PMID 11805178.
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  12. ↑ Pollock, C A (2001). "Diagnosis and management of encapsulating peritoneal sclerosis". Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis. 21 (3): S61–S66. doi:10.1177/089686080102103S10. PMID 11887865.
  13. 1 2 Kawanishi, Hideki; Moriishi, Misaki (April 2005). "Epidemiology of encapsulating peritoneal sclerosis in Japan". Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis. 25 (4): S14–S18. PMID 16300268.
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  16. ↑ Yamamoto, Ryo; Otsuka, Yasushi; Nakayama, Masaaki; Maruyama, Yukio; Katoh, Naohiko; Ikeda, Masato; Yamamoto, Hiroyasu; Yokoyama, Keitaro; Kawaguchi, Yoshindo; Matsushima, Masato (June 24, 2005). "Risk factors for encapsulating peritoneal sclerosis in patients who have experienced peritoneal dialysis treatment". Clinical and Experimental Nephrology. Springer Science and Business Media LLC. 9 (2): 148–152. doi:10.1007/s10157-005-0349-8. ISSN 1342-1751. PMID 15980950. S2CID 26144928.
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  29. ↑ Takebayashi, Katsushi; Sonoda, Hiromichi; Shimizu, Tomoharu; Ohta, Hiroyuki; Ishida, Mitsuaki; Mekata, Eiji; Endo, Yoshihiro; Tani, Tohru; Tani, Masaji (August 27, 2014). "Successful surgical approach for a patient with encapsulating peritoneal sclerosis after hyperthermic intraperitoneal chemotherapy: a case report and literature review". BMC Surgery. Springer Science and Business Media LLC. 14 (1): 57. doi:10.1186/1471-2482-14-57. ISSN 1471-2482. PMC 4149037. PMID 25160862.
  30. ↑ Sigaroudinia, Mandana O.; Baillie, Colin; Ahmed, Shiban; Mallucci, Connor (2008). "Sclerosing encapsulating peritonitis—a rare complication of ventriculoperitoneal shunts". Journal of Pediatric Surgery. Elsevier BV. 43 (5): e31–e33. doi:10.1016/j.jpedsurg.2008.01.019. ISSN 0022-3468.
  31. ↑ Arnadottir, M.; Jonasson, J. G.; Indridason, O. S. (February 11, 2011). "Encapsulating peritoneal sclerosis following a peritoneal foreign body reaction to Dacron fibres--a case report". Clinical Kidney Journal. Oxford University Press (OUP). 4 (2): 107–109. doi:10.1093/ndtplus/sfq202. ISSN 2048-8505. PMC 4421583. PMID 25984126.
  32. ↑ Hsu, Yung-Hsuen; Hsia, Ching-Chih; Tsai, Dong-Ming; Tu, Hsing-Yang; Hung, Kuan-Yu; Huang, Jenq-Wen (2010). "Development of Encapsulating Peritoneal Sclerosis Following Bacterial Peritonitis in a Peritoneal Dialysis Patient". American Journal of Kidney Diseases. Elsevier BV. 55 (1): 198–202. doi:10.1053/j.ajkd.2009.06.043. ISSN 0272-6386. PMID 19782452.
  33. ↑ Tan, J.; Manickam, R.; Pisharam, J.; Telisinghe, P.; Chong, V.H. (2012). "Mucormycosis—A Possible Trigger Pathogen for Encapsulating Peritoneal Sclerosis". Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis. SAGE Publications. 32 (4): 479–481. doi:10.3747/pdi.2011.00241. ISSN 0896-8608. PMC 3524856. PMID 22859845.
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  37. 1 2 Johnson, David W.; Cho, Yeoungjee; Livingston, Brian E.R.; Hawley, Carmel M.; McDonald, Stephen P.; Brown, Fiona G.; Rosman, Johan B.; Bannister, Kym M.; Wiggins, Kathryn J. (2010). "Encapsulating peritoneal sclerosis: incidence, predictors, and outcomes". Kidney International. Elsevier BV. 77 (10): 904–912. doi:10.1038/ki.2010.16. ISSN 0085-2538. PMID 20375981.
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  39. ↑ Abrahams, Alferso C.; Habib, Sayed M.; Dendooven, Amélie; Riser, Bruce L.; van der Veer, Jan Willem; Toorop, Raechel J.; Betjes, Michiel G. H.; Verhaar, Marianne C.; Watson, Christopher J. E.; Nguyen, Tri Q.; Boer, Walther H. (November 10, 2014). "Patients with Encapsulating Peritoneal Sclerosis Have Increased Peritoneal Expression of Connective Tissue Growth Factor (CCN2), Transforming Growth Factor-β1, and Vascular Endothelial Growth Factor". PLOS ONE. Public Library of Science (PLoS). 9 (11): e112050. Bibcode:2014PLoSO...9k2050A. doi:10.1371/journal.pone.0112050. ISSN 1932-6203. PMC 4226475. PMID 25384022.
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  42. ↑ Lopez-Anton, Melisa; Lambie, Mark; Lopez-Cabrera, Manuel; Schmitt, Claus P.; Ruiz-Carpio, Vicente; Bartosova, Maria; Schaefer, Betti; Davies, Simon; Stone, Timothy; Jenkins, Robert; Taylor, Philip R.; Topley, Nicholas; Bowen, Timothy; Fraser, Donald (2017). "miR-21 Promotes Fibrogenesis in Peritoneal Dialysis". The American Journal of Pathology. Elsevier BV. 187 (7): 1537–1550. doi:10.1016/j.ajpath.2017.03.007. ISSN 0002-9440. PMID 28495592.
  43. ↑ Reimold, Fabian R.; Braun, Niko; Zsengellér, Zsuzsanna K.; Stillman, Isaac E.; Karumanchi, S. Ananth; Toka, Hakan R.; Latus, Joerg; Fritz, Peter; Biegger, Dagmar; Segerer, Stephan; Alscher, M. Dominik; Bhasin, Manoj K.; Alper, Seth L. (February 13, 2013). "Transcriptional Patterns in Peritoneal Tissue of Encapsulating Peritoneal Sclerosis, a Complication of Chronic Peritoneal Dialysis". PLOS ONE. Public Library of Science (PLoS). 8 (2): e56389. Bibcode:2013PLoSO...856389R. doi:10.1371/journal.pone.0056389. ISSN 1932-6203. PMC 3572070. PMID 23418565.
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  49. 1 2 3 Ti, Joanna P.; Al-Aradi, Ali; Conlon, Peter J.; Lee, Michael J.; Morrin, Martina M. (2010). "Imaging Features of Encapsulating Peritoneal Sclerosis in Continuous Ambulatory Peritoneal Dialysis Patients". American Journal of Roentgenology. American Roentgen Ray Society. 195 (1): W50–W54. doi:10.2214/ajr.09.3175. ISSN 0361-803X.
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  54. ↑ Braun, Niko; Fritz, Peter; Ulmer, Christoph; Latus, Joerg; Kimmel, Martin; Biegger, Dagmar; Ott, German; Reimold, Fabian; Thon, Klaus-Peter; Dippon, Juergen; Segerer, Stephan; Alscher, M. Dominik (November 7, 2012). "Histological Criteria for Encapsulating Peritoneal Sclerosis – A Standardized Approach". PLOS ONE. Public Library of Science (PLoS). 7 (11): e48647. Bibcode:2012PLoSO...748647B. doi:10.1371/journal.pone.0048647. ISSN 1932-6203. PMID 23144917.
  55. 1 2 Kawanishi, Hideki; Kawaguchi, Yoshindo; Fukui, Hiroyoshi; Hara, Shigeko; Imada, Akio; Kubo, Hitoshi; Kin, Masao; Nakamoto, Masahiko; Ohira, Seiji; Shoji, Takao (2004). "Encapsulating peritoneal sclerosis in Japan: a prospective, controlled, multicenter study". American Journal of Kidney Diseases : The Official Journal of the National Kidney Foundation. 44 (4): 729–737. doi:10.1016/S0272-6386(04)00953-9. PMID 15384025.
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  57. ↑ Freitas, Declan de; Jordaan, Antoinette; Williams, Rosalind; Alderdice, Jane; Curwell, Janet; Hurst, Helen; Hutchison, Alastair; Brenchley, Paul E C; Augustine, Titus; Summers, Angela M (2008). "Nutritional management of patients undergoing surgery following diagnosis with encapsulating peritoneal sclerosis". Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis. 28 (3): 271–276. doi:10.1177/089686080802800314. PMID 18474920. S2CID 40920566.
  58. ↑ Sud, Rahul; Garry, Lorraine; Spicer, Stephen Timothy; Allen, Richard DM; Eris, Josette M; Wyburn, Kate; Verran, Deborah; Cooper, Caroline Louise; Chadban, Steve (March 14, 2014). "A role for everolimus in post-transplant encapsulating peritoneal sclerosis: First case report". Nephrology. Wiley. 19 (S1): 27–30. doi:10.1111/nep.12196. ISSN 1320-5358. PMID 24460661. S2CID 30166094.
  59. ↑ Romagnoli, J.; Pedroso, J.A.; Paola Salerno, M.; Favi, E.; Spagnoletti, G.; Citterio, F. (2014). "Posttransplant Encapsulating Peritoneal Sclerosis, Long-Term Success With Everolimus and Low-Dose CNI: A Case Report". Transplantation Proceedings. Elsevier BV. 46 (7): 2368–2370. doi:10.1016/j.transproceed.2014.07.060. ISSN 0041-1345.
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  63. ↑ Loureiro, Jesús; Aguilera, Abelardo; Selgas, Rafael; Sandoval, Pilar; Albar-Vizcaíno, Patricia; Pérez-Lozano, María Luisa; Ruiz-Carpio, Vicente; Majano, Pedro L.; Lamas, Santiago; Rodríguez-Pascual, Fernando; Borras-Cuesta, Francisco; Dotor, Javier; López-Cabrera, Manuel (2011). "Blocking TGF-β1 Protects the Peritoneal Membrane from Dialysate-Induced Damage". Journal of the American Society of Nephrology. Ovid Technologies (Wolters Kluwer Health). 22 (9): 1682–1695. doi:10.1681/asn.2010111197. hdl:10486/668378. ISSN 1046-6673. PMID 21742730.
  64. ↑ Célicout, Betty; Levard, Hugues; Hay, Jean-Marie; Msika, Simon; Fingerhut, Abe; Pelissier, Edouard; French Associations for Surgical Research, F (1998). "Sclerosing Encapsulating Peritonitis: Early and Late Results of Surgical Management in 32 Cases". Digestive Surgery. S. Karger AG. 15 (6): 697–702. doi:10.1159/000018681. ISSN 0253-4886. S2CID 46805116.
  65. ↑ Ulmer, Christoph; Braun, Niko; Rieber, Fabian; Latus, Joerg; Hirschburger, Sandra; Emmel, Jens; Alscher, M. Dominik; Steurer, Wolfgang; Thon, Klaus-Peter (2013). "Efficacy and morbidity of surgical therapy in late-stage encapsulating peritoneal sclerosis". Surgery. Elsevier BV. 153 (2): 219–224. doi:10.1016/j.surg.2012.07.033. ISSN 0039-6060.
  66. ↑ Brown, Michaela C.; Simpson, Keith; Kerssens, Jan J.; Mactier, Robert A. (2009). "Encapsulating Peritoneal Sclerosis in the New Millennium". Clinical Journal of the American Society of Nephrology. Ovid Technologies (Wolters Kluwer Health). 4 (7): 1222–1229. doi:10.2215/cjn.01260209. ISSN 1555-9041. PMC 2709523. PMID 19541815.
  67. ↑ Jagirdar, Rajesh M.; Bozikas, Andreas; Zarogiannis, Sotirios G.; Bartosova, Maria; Schmitt, Claus Peter; Liakopoulos, Vassilios (November 16, 2019). "Encapsulating Peritoneal Sclerosis: Pathophysiology and Current Treatment Options". International Journal of Molecular Sciences. MDPI AG. 20 (22): 5765. doi:10.3390/ijms20225765. ISSN 1422-0067. PMC 6887950. PMID 31744097.
  68. ↑ Lambie, Mark; Teece, Lucy; Johnson, David W; Petrie, Michaela; Mactier, Robert; Solis-Trapala, Ivonne; Belcher, John; Bekker, Hilary L; Wilkie, Martin; Tupling, Ken; Phillips-Darby, Louise; Davies, Simon J (February 28, 2019). "Estimating risk of encapsulating peritoneal sclerosis accounting for the competing risk of death". Nephrology Dialysis Transplantation. Oxford University Press (OUP). 34 (9): 1585–1591. doi:10.1093/ndt/gfz034. ISSN 0931-0509. PMC 6735880.

Further reading

  • Singhal, Manphool; Krishna, Satheesh; Lal, Anupam; Narayanasamy, Sabarish; Bal, Amanjit; Yadav, Thakur D.; Kochhar, Rakesh; Sinha, Saroj K.; Khandelwal, Niranjan; Sheikh, Adnan M. (2019). "Encapsulating Peritoneal Sclerosis: The Abdominal Cocoon". RadioGraphics. Radiological Society of North America (RSNA). 39 (1): 62–77. doi:10.1148/rg.2019180108. ISSN 0271-5333. S2CID 54470904.
  • Korte, Mario R.; Sampimon, Denise E.; Betjes, Michiel G. H.; Krediet, Raymond T. (August 2, 2011). "Encapsulating peritoneal sclerosis: the state of affairs". Nature Reviews Nephrology. Springer Science and Business Media LLC. 7 (9): 528–538. doi:10.1038/nrneph.2011.93. ISSN 1759-5061. PMID 21808281. S2CID 21841526.
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