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

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• 作者：Jason J.  ; Lewis MD¹ ; Joel H.  ; Rubenstein MD ; MSc² ; Amit G.  ; Singal MD ; MSc¹ ; B. Joseph  ; Elmunzer MD¹ ; Richard S.  ; Kwon MD¹ ; Cyrus R.  ; Piraka MD¹ ;   ;
• 刊名：Gastrointestinal Endoscopy
• 出版年：2011
• 出版时间：October 2011
• 年：2011
• 卷：74
• 期：4
• 页码：753-760
• 全文大小：787 K

文摘

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.