Clin Endosc.  2014 Mar;47(2):155-161. 10.5946/ce.2014.47.2.155.

Predictors of Esophageal Stricture Formation Post Endoscopic Mucosal Resection

• Qumseya B
• Panossian
• Rizk C
• Cangemi D
• Wolfsen C
• Raimondo M
• Woodward T
• Wallace MB
• Wolfsen H

• KMID: 2049003
• DOI: http://doi.org/10.5946/ce.2014.47.2.155

Abstract

BACKGROUND/AIMS
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.

Keyword

Endoscopy; Complications; Esophageal stenosis; Barrett esophagus

MeSH Terms

Barrett Esophagus
Constriction, Pathologic
Deglutition Disorders
Endoscopy
Esophageal Stenosis*
Follow-Up Studies
Humans
Logistic Models
Prospective Studies
Retrospective Studies
Risk Factors
Tertiary Care Centers

Figure

• 

  Fig. 1 Endoscopic mucosal resection with the "rosette" technique. (A) Esophageal nodule in the background of Barrett's esophagus as seen in high-definition white light. (B) Same nodule as seen in narrow-band imaging. (C) Mucosal defect after resection of the nodule. (D) Large mucosal defect after completion of the rosette resection. (E) Specimens embedded on paraffin wax. (F) Endoscopic view of an esophageal stricture post endoscopic mucosal resection (before dilation).

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