Factors associated with esophageal stricture formation after endoscopic mucosal resection for neoplastic Barrett's esophagus.

Abstract

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.

• Authors: Jason J Lewis, Joel H Rubenstein, Amit G Singal, B Joseph Elmunzer, Richard S Kwon, Cyrus R Piraka
• Journal: Gastrointestinal endoscopy (Gastrointest Endosc) Vol. 74 Issue 4 Pg. 753-60 (Oct 2011) ISSN: 1097-6779 [Electronic] United States
• PMID: 21820109 (Publication Type: Journal Article)
• Copyright: Copyright © 2011 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Topics

• Aged
• Aged, 80 and over
• Barrett Esophagus (surgery)
• Esophageal Neoplasms (surgery)
• Esophageal Stenosis (etiology)
• Esophagoscopy (adverse effects)
• Female
• Humans
• Male
• Middle Aged
• Mucous Membrane (surgery)