title: Predictors of stricture formation after photodynamic therapy for high-grade dysplasia in Barrett's esophagus.
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).
  
  
  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.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
authors.forename: Ganapathy A
authors.initials: GA
authors.lastname: Prasad
authors.forename: Kenneth K
authors.initials: KK
authors.lastname: Wang
authors.forename: Navtej S
authors.initials: NS
authors.lastname: Buttar
authors.forename: Louis-Michel
authors.initials: LM
authors.lastname: Wongkeesong
authors.forename: Lori S
authors.initials: LS
authors.lastname: Lutzke
authors.forename: Lynn S
authors.initials: LS
authors.lastname: Borkenhagen
mesh_terms: 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
chemical_list: D017319:Photosensitizing Agents; D017323:Dihematoporphyrin Ether