Predictors of stricture formation after photodynamic therapy for high-grade dysplasia in Barrett's esophagus{A figure is presented}

Ganapathy A. Prasad, Kenneth K. Wang, Navtej S. Buttar, Louis Michel Wongkeesong, Lori S. Lutzke, Lynn S. Borkenhagen

Research output: Contribution to journalArticle

72 Scopus citations

Abstract

Background: Stricture formation is the leading cause of long-term morbidity after photodynamic therapy (PDT). Risk factors for stricture formation have not been studied. Objective: To assess risk factors for stricture formation in patients undergoing PDT for Barrett's esophagus with high-grade dysplasia (HGD). Design: Retrospective cohort study. Setting: Barrett's Unit, Mayo Clinic, Rochester, Minnesota. Methods: Records of patients undergoing PDT for HGD were reviewed. Patients underwent PDT by using either bare cylindrical diffusing fibers (2.5-5.0 cm in length) or balloon diffusers with 5- to 7-cm windows. Univariate and multivariate logistic regression analyses were performed to assess risk factors for stricture formation. Main Outcome Measurement: Esophageal stricture formation. Results: Thirty-five of 131 patients (27%) developed strictures. On multivariate analysis, statistically significant predictors of stricture formation were the following: EMR before PDT was odds ratio (OR) 2.7, 95% confidence interval (CI) 1.13-6.59; a prior history of esophageal stricture was OR 2.7, 95% CI 1.15-6.47; and the number of PDT applications was OR 2.2, 95% CI 1.22-4.12. The OR for stricture formation in patients when centering balloons were used was 0.41, 95% CI 0.11-1.46, P = .168, indicating that centering balloons did not significantly decrease the risk of stricture formation. Limitations: Retrospective single-center study; small proportion of patients treated with centering balloons. Conclusions: Risk factors for development of strictures after PDT included history of a prior esophageal stricture, performance of EMR before PDT, and more than 1 PDT application in 1 treatment session. The use of centering balloons was not associated with a statistically significant reduction in the risk of stricture formation.

Original languageEnglish (US)
Pages (from-to)60-66
Number of pages7
JournalGastrointestinal endoscopy
Volume65
Issue number1
DOIs
StatePublished - Jan 1 2007

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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