Predictors of esophageal stricture formation post endoscopic mucosal resection.
OBJECTIVE
Stricture formation is a common complication after endoscopic mucosal resection. Predictors of stricture formation have not been well studied.


METHODS
We conducted a retrospective, observational, descriptive study by using a prospective endoscopic mucosal resection database in a tertiary referral center. For each patient, we extracted the age, sex, lesion size, use of ablative therapy, and detection of esophageal strictures. The primary outcome was the presence of esophageal stricture at follow-up. Multivariate logistic regression was used to analyze the association between the primary outcome and predictors.


RESULTS
Of 136 patients, 27% (n=37) had esophageal strictures. Thirty-two percent (n=44) needed endoscopic dilation to relieve dysphagia (median, 2; range, 1 to 8). Multivariate logistic regression analysis showed that the size of the lesion excised is associated with increased odds of having a stricture (odds ratio, 1.6; 95% confidence interval, 1.1 to 2.3; p=0.01), when controlling for age, sex, and ablative modalities. Similarly, the number of lesions removed in the index procedure was associated with increased odds of developing a stricture (odds ratio, 2.3; 95% confidence interval, 1.3 to 4.2; p=0.007).


CONCLUSIONS
Stricture formation after esophageal endoscopic mucosal resection is common. Risk factors for stricture formation include large mucosal resections and the resection of multiple lesions on the initial procedure.
Department of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, FL, USA.
Bashar
B
Qumseya
Department of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, FL, USA. ; Mercy Gilbert Medical Center, Chandler, AZ, USA.
Abraham M
AM
Panossian
Department of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, FL, USA. ; Department of Family Medicine, The Pennsylvania State University Medical Center, Hershey, PA, USA.
Cynthia
C
Rizk
Community Internal Medicine at Mayo Clinic, Jacksonville, FL, USA.
David
D
Cangemi
Department of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, FL, USA.
Christianne
C
Wolfsen
Department of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, FL, USA.
Massimo
M
Raimondo
Department of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, FL, USA.
Timothy
T
Woodward
Department of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, FL, USA.
Michael B
MB
Wallace
Department of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, FL, USA.
Herbert
H
Wolfsen
Barrett esophagus; Complications; Endoscopy; Esophageal stenosis