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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). 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.

journal_name

Gastrointest Endosc

journal_title

Gastrointestinal endoscopy

authors

Prasad GA,Wang KK,Buttar NS,Wongkeesong LM,Lutzke LS,Borkenhagen LS

doi

10.1016/j.gie.2006.04.028

subject

Has Abstract

pub_date

2007-01-01 00:00:00

pages

60-6

issue

1

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(06)01897-9

journal_volume

65

pub_type

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