Predictors of stricture formation after photodynamic therapy for high-grade dysplasia in Barrett's esophagus.
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).


METHODS
Retrospective cohort study.


METHODS
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.


METHODS
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.


CONCLUSIONS
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.
Prasad
Ganapathy A
GA
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
Wang
Kenneth K
KK
Buttar
Navtej S
NS
Wongkeesong
Louis-Michel
LM
Lutzke
Lori S
LS
Borkenhagen
Lynn S
LS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000188:drug therapy* / Q000473:pathology; D017323:Dihematoporphyrin Ether / Q000009:adverse effects* / Q000627:therapeutic use; D004940:Esophageal Stenosis / Q000139:chemically induced / Q000453:epidemiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000601:surgery; D015999:Multivariate Analysis; D016017:Odds Ratio; D010778:Photochemotherapy / Q000009:adverse effects*; D017319:Photosensitizing Agents / Q000009:adverse effects* / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors
D017319:Photosensitizing Agents; D017323:Dihematoporphyrin Ether