title: Treatment of Refractory Gastrointestinal Strictures With Mitomycin C: A Systematic Review.
abstract: OBJECTIVE
  Refractory benign gastrointestinal (GI) strictures represent a difficult management problem given the limited therapeutic interventions available. We performed a systematic review of all published cases using mitomycin C in the treatment of GI strictures.
  
  
  METHODS
  Searches of MEDLINE and Embase databases were performed to identify studies reporting application of mitomycin C for GI strictures. Review of titles/abstracts, full review of potentially relevant studies, and data abstraction were performed independently by 2 authors.
  
  
  RESULTS
  Of 549 citations, 24 studies with 145 patients (74% pediatric and 26% adult) met inclusion criteria. Esophageal strictures were the most common (79%) site of refractory strictures treated with mitomycin C, with caustic injury the most common underlying etiology. The concentration (range, 0.1 to 2 mg/mL; median, 0.4 mg/mL), number of applications (range, 1 to 12; median, 1), duration of applications (range, 1 to 5; median, 2 min), and technique of application (cotton pledget, spray, injection, special catheters) varied among studies. Ninety-one patients (73%; children: 80%, adults: 59%) had a complete response; 26 (21%) had a partial response. Only 1 (0.7%) adverse event was reported: cutaneous sclerosis attributed to microperforation and mitomycin C extravastion after injection. Mean follow-up was 23 (4 to 60) months.
  
  
  CONCLUSIONS
  Local mitomycin C application seems to be a safe and effective therapy for benign refractory GI strictures of varying etiology in both pediatric and adult populations. Although the results of this systematic review are highly encouraging, it should be considered investigational. Additional randomized trials and larger prospective studies are needed to confirm these results and to better define the optimal dose, concentration, duration and technique of mitomycin C application.
authors.affiliation: *Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven †VA Connecticut Healthcare System, West Haven, CT.
authors.forename: Tarun
authors.initials: T
authors.lastname: Rustagi
authors.forename: Harry R
authors.initials: HR
authors.lastname: Aslanian
authors.forename: Loren
authors.initials: L
authors.lastname: Laine
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic / Q000188:drug therapy; D004940:Esophageal Stenosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007223:Infant; D007410:Intestinal Diseases / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage* / Q000009:adverse effects; D019384:Nucleic Acid Synthesis Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D010608:Pharyngeal Diseases / Q000188:drug therapy* / Q000473:pathology; D055815:Young Adult
chemical_list: D019384:Nucleic Acid Synthesis Inhibitors; D016685:Mitomycin