title: Topical mitomycin C versus intralesional triamcinolone in the management of esophageal stricture due to caustic ingestion.
abstract: BACKGROUND
  Esophageal stricture due to caustic ingestion is one of the most difficult problems to manage. Esophageal dilations are the usual treatment and they require a great number of sessions in the majority of cases. This implies time, risks for the patient, anguish for the relatives, and very often, frustration for the physician.
  
  
  OBJECTIVE
  To evaluate the efficacy of the application of topical mitomycin C and intralesional triamcinolone in the prevention of post-dilation esophageal stricture recurrence.
  
  
  METHODS
  A prospective, comparative, nonrandomized, and longitudinal study was conducted that compared a cohort of 16 patients treated with mitomycin C (2009-2012) with a retrospective cohort of 34 patients treated with triamcinolone (2002-2009).
  
  
  RESULTS
  The patients treated with intralesional triamcinolone had a median of 11 dilations (minimum 4 and maximum 24), whereas the median in the patients treated with topical mitomycin C was 4.5 (minimum 3 and maximum 8). The groups were compared using the Mann-Whitney U test, finding a statistically significant difference of a two-tailed P<.001. In the multiple linear regression model, the dependent variable was the number of dilations and the independent variables were the type of lesion and treatment. The result was an R(2) .676 with a significance level of P<.001, in which the regression coefficient for treatment was B -.682 (95% CI -8.286 to -5.025) and the lesion grade was B .435 (95% CI 2.043- 4.573). The ANOVA result was an F 49.08 and a P<.001 and showed that the independent variables of type of lesion and treatment had a linear relation with the number of dilations, reinforcing the fact that our results were not due to chance.
  
  
  CONCLUSIONS
  Topical mitomycin C considerably reduced the number of esophageal dilations compared with the use of intralesional triamcinolone to alleviate dysphagia, and therefore we suggest it as a treatment option in strictures due to caustic ingestion.
authors.affiliation: Departamento de Gastroenterología y Endoscopia, Hospital Ángeles, Ciudad Juárez, Chihuahua, México. Electronic address: deniskar@yahoo.com.
authors.forename: C M
authors.initials: CM
authors.lastname: Méndez-Nieto
authors.affiliation: Departamento de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, México, D.F., México.
authors.forename: F
authors.initials: F
authors.lastname: Zarate-Mondragón
authors.affiliation: Departamento de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, México, D.F., México.
authors.forename: J
authors.initials: J
authors.lastname: Ramírez-Mayans
authors.affiliation: Departamento de Enseñanza, Hospital General de Zona No. 35, Ciudad Juárez, Chihuahua, México.
authors.forename: M
authors.initials: M
authors.lastname: Flores-Flores
mesh_terms: D000287:Administration, Topical; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage* / Q000627:therapeutic use; D002057:Burns, Chemical / Q000150:complications*; D002424:Caustics / Q000633:toxicity; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004106:Dilatation; D004940:Esophageal Stenosis / Q000139:chemically induced / Q000188:drug therapy* / Q000628:therapy; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D007223:Infant; D015552:Injections, Intralesional; D008137:Longitudinal Studies; D008297:Male; D016685:Mitomycin / Q000008:administration & dosage* / Q000627:therapeutic use; D011446:Prospective Studies; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014221:Triamcinolone / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D000893:Anti-Inflammatory Agents; D000903:Antibiotics, Antineoplastic; D002424:Caustics; D014221:Triamcinolone; D016685:Mitomycin
keywords: Caustic ingestion; Dilatación esofágica; Esophageal dilation; Esophageal stricture; Estenosis esofágica; Ingestión de cáusticos; Mitomicina C; Mitomycin C; Triamcinolona; Triamcinolone