TY - JOUR
T1 - Factors associated with esophageal stricture formation after endoscopic mucosal resection for neoplastic Barrett's esophagus
AU - Lewis, Jason J.
AU - Rubenstein, Joel H.
AU - Singal, Amit G.
AU - Elmunzer, B. Joseph
AU - Kwon, Richard S.
AU - Piraka, Cyrus R.
PY - 2011/10
Y1 - 2011/10
N2 - Background: EMR for early neoplastic Barrett's esophagus is gaining favor over esophagectomy. Esophageal stricture development has been reported as a common complication of EMR, photodynamic therapy, and combination endoscopic therapy. Objective: To determine clinical and procedural predictors of symptomatic stricture formation after EMR. Design: Retrospective analysis. Setting: Tertiary-care referral university hospital. Patients: Data were retrospectively reviewed on 73 patients at our institution who underwent EMR monotherapy for Barrett's esophagus with high-grade dysplasia or intramucosal cancer since January 2006. Intervention: EMR. Main Outcome Measurements: Symptomatic esophageal stricture formation. Results: Symptomatic esophageal stricture formation was noted in 24.7% of patients undergoing EMR. Stricture formation on univariate analysis was associated with percentage of circumference of esophageal lumen resected, total pieces resected, number of EMR sessions, and tobacco use. A threshold effect was found at 50% of esophageal circumference resected (66.7% vs 27.2% developed strictures above and below the threshold, respectively; P =.004). A 25-pack-year or greater history of tobacco use had a threshold effect on esophageal stricture formation (77.8% vs 7.2% developed strictures above and below the threshold, respectively; P =.02). In multivariate analysis, resection of >50% of the circumference was strongly associated with stricture formation (odds ratio [OR] 4.17; 95% confidence interval [CI], 1.27-13.7). A 25-pack-year or greater history of tobacco use also trended toward stricture formation (OR 3.33; 95% CI, 0.929-12.1). Limitations: Retrospective design, sample size. Conclusion: Resection of at least 50% of the esophageal mucosal circumference is strongly associated with stricture formation. Patients with strong histories of tobacco use also may be more likely to develop esophageal strictures following EMR.
AB - Background: EMR for early neoplastic Barrett's esophagus is gaining favor over esophagectomy. Esophageal stricture development has been reported as a common complication of EMR, photodynamic therapy, and combination endoscopic therapy. Objective: To determine clinical and procedural predictors of symptomatic stricture formation after EMR. Design: Retrospective analysis. Setting: Tertiary-care referral university hospital. Patients: Data were retrospectively reviewed on 73 patients at our institution who underwent EMR monotherapy for Barrett's esophagus with high-grade dysplasia or intramucosal cancer since January 2006. Intervention: EMR. Main Outcome Measurements: Symptomatic esophageal stricture formation. Results: Symptomatic esophageal stricture formation was noted in 24.7% of patients undergoing EMR. Stricture formation on univariate analysis was associated with percentage of circumference of esophageal lumen resected, total pieces resected, number of EMR sessions, and tobacco use. A threshold effect was found at 50% of esophageal circumference resected (66.7% vs 27.2% developed strictures above and below the threshold, respectively; P =.004). A 25-pack-year or greater history of tobacco use had a threshold effect on esophageal stricture formation (77.8% vs 7.2% developed strictures above and below the threshold, respectively; P =.02). In multivariate analysis, resection of >50% of the circumference was strongly associated with stricture formation (odds ratio [OR] 4.17; 95% confidence interval [CI], 1.27-13.7). A 25-pack-year or greater history of tobacco use also trended toward stricture formation (OR 3.33; 95% CI, 0.929-12.1). Limitations: Retrospective design, sample size. Conclusion: Resection of at least 50% of the esophageal mucosal circumference is strongly associated with stricture formation. Patients with strong histories of tobacco use also may be more likely to develop esophageal strictures following EMR.
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U2 - 10.1016/j.gie.2011.05.031
DO - 10.1016/j.gie.2011.05.031
M3 - Article
C2 - 21820109
AN - SCOPUS:80053274826
SN - 0016-5107
VL - 74
SP - 753
EP - 760
JO - Gastrointestinal endoscopy
JF - Gastrointestinal endoscopy
IS - 4
ER -