Topical application of mitomycin-C in oesophageal strictures.
BACKGROUND
Benign oesophageal strictures may occur as a complication of caustic ingestion or severe gastro-oesophageal reflux or as a sequela of oesophageal surgery and other fibrosing conditions. The traditional initial treatment of oesophageal strictures is intraluminal dilation; however, even if frequent, this occasionally may not provide adequate oesophageal lumen capacity or give significant symptom-free intervals, and restricturing after dilation is difficult and challenging. Topical postdilation application of an antifibrotic agent, mitomycin-C, in the treatment of an oesophageal stricture has been described.


METHODS
Eight centres participated, with a total of 16 patients (4 girls), median age 48 (range 0-276) months. The causes of stricture were as follows: caustic (10), post-trachea-oesophageal fistula repair (2), peptic (2), Crohn disease (1), and dystrophic epidermolysis bullosa (1). The median (range) length and diameter of the strictures were as follows: 22 mm (8-50 mm) and 1.5 mm (1-6 mm). Of the 16 patients, 15 had undergone repeated dilations varying from 3 to more than 1000 (daily self-bouginage) before mitomycin-C, and the median interval between dilations was 4 weeks. Mitomycin-C 0.1 mg/mL was applied after dilation for a median time of 3.5 minutes and a median of 3 (1-12) times.


RESULTS
Major success, both endoscopic and clinical improvement or cure, occurred in 10 of 16 patients. In 3 of 16 patients the interval period between dilations increased dramatically. Failure of therapy was considered in 3 of 16. All of the patients remained symptom free for a follow-up time of as long as 5 years.


CONCLUSIONS
Postdilation application of topical mitomycin-C resulted in major success in 62.5% of patients and partial success in 19%, and it may be a useful strategy in oesophageal strictures of differing causes that are refractory to repeated perendoscopic dilation.
Rosseneu
S
S
Royal Free Hospital, London, UK.
Afzal
N
N
Yerushalmi
B
B
Ibarguen-Secchia
E
E
Lewindon
P
P
Cameron
D
D
Mahler
T
T
Schwagten
K
K
Köhler
H
H
Lindley
K J
KJ
Thomson
M
M
D000287:Administration, Topical; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D002675:Child, Preschool; D004106:Dilatation; D004940:Esophageal Stenosis / Q000188:drug therapy* / Q000628:therapy; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016685:Mitomycin / Q000008:administration & dosage*
D000893:Anti-Inflammatory Agents; D016685:Mitomycin