title: Factors associated with esophageal stricture formation after endoscopic mucosal resection for neoplastic Barrett's esophagus.
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.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  Tertiary-care referral university hospital.
  
  
  METHODS
  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.
  
  
  METHODS
  EMR.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  Retrospective design, sample size.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Michigan Health System, Ann Arbor Michigan, USA.
authors.forename: Jason J
authors.initials: JJ
authors.lastname: Lewis
authors.forename: Joel H
authors.initials: JH
authors.lastname: Rubenstein
authors.forename: Amit G
authors.initials: AG
authors.lastname: Singal
authors.forename: B Joseph
authors.initials: BJ
authors.lastname: Elmunzer
authors.forename: Richard S
authors.initials: RS
authors.lastname: Kwon
authors.forename: Cyrus R
authors.initials: CR
authors.lastname: Piraka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000601:surgery*; D004940:Esophageal Stenosis / Q000209:etiology*; D004945:Esophagoscopy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000601:surgery