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. 2011 Oct;74(4):753-60.
doi: 10.1016/j.gie.2011.05.031. Epub 2011 Aug 5.

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

Jason J Lewis  1 , Joel H Rubenstein, Amit G Singal, B Joseph Elmunzer, Richard S Kwon, Cyrus R Piraka
Affiliations

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

Jason J Lewis et al. Gastrointest Endosc. 2011 Oct.

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.

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Figures

Figure 1
Figure 1
Endoscopic resection of 25% of the esophageal lumen.
Figure 2
Figure 2
Endoscopic resection of 50% of the esophageal lumen.
Figure 3
Figure 3
Endoscopic resection of 75% of the esophageal lumen.
Figure 4
Figure 4
Effect of percentage of esophageal circumference resected on symptomatic esophageal stricture formation.
Figure 5
Figure 5
Effect of tobacco pack-year exposure on esophageal stricture.
See this image and copyright information in PMC

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