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.
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.
Authors: Ganapathy A Prasad; Kenneth K Wang; Navtej S Buttar; Louis-Michel Wongkeesong; Kausilia K Krishnadath; Francis C Nichols; Lori S Lutzke; Lynn S Borkenhagen Journal: Gastroenterology Date: 2007-02-07 Impact factor: 22.682
Authors: Jason J Lewis; Joel H Rubenstein; Amit G Singal; B Joseph Elmunzer; Richard S Kwon; Cyrus R Piraka Journal: Gastrointest Endosc Date: 2011-08-05 Impact factor: 9.427
Authors: Rami J Badreddine; Ganapathy A Prasad; Kenneth K Wang; Louis M Wong Kee Song; Navtej S Buttar; Kelly T Dunagan; Lori S Lutzke; Lynn S Borkenhagen Journal: Gastrointest Endosc Date: 2009-12-03 Impact factor: 9.427
Authors: Stuart Jon Spechler; Rebecca C Fitzgerald; Ganapathy A Prasad; Kenneth K Wang Journal: Gastroenterology Date: 2010-01-18 Impact factor: 22.682