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Endoscopic postdilatation application of Mitomycin C in children with resistant esophageal strictures

  • Rashed, Yasser K. (Department of Pediatric Hepatology, National Liver Institute, Menoufiya University) ;
  • El-Guindi, Mohamed (Department of Pediatric Hepatology, Gastroenterology and Nutrition, National Liver Institute, Menoufia University)
  • Received : 2018.10.07
  • Accepted : 2019.06.22
  • Published : 2019.10.15

Abstract

Background: The esophagus is the most common part of gastrointestinal (GI) tract at the risk of stricture. Benign disorders are the leading causes of narrowing. Caustic ingestion is the most common cause of esophageal stricture in children, especially in developing countries. Clinical responses to the topical application of Mitomycin C in various medical procedures have been reported. Purpose: The study aimed to evaluate the methodology, efficacy, and side effects of Mitomycin C in the treatment of esophageal strictures. Methods: This study included 30 children with resistant esophageal strictures. Upper GI endoscopy was performed up to the area of stricture, esophageal dilatation was done, endoscopy was repeated, and Mitomycin C was applied topically under direct endoscopic vision. The effect of the procedure was followed over a period of 3-5 years. Results: The response to Mitomycin C was excellent (clinically and endoscopically) in 28 patients (93.3%) and good (endoscopically only) in 2 patients (6.7%). No side effects of topical Mitomycin C in children with esophageal strictures were reported in this study. Conclusion: Esophageal dilatation followed by local Mitomycin C application may be a useful strategy for treating resistant esophageal strictures.

Keywords

References

  1. Contini S, Scarpignato C. Caustic injury of the upper gastrointestinal tract: a comprehensive review. World J Gastroenterol 2013;19:3918-30. https://doi.org/10.3748/wjg.v19.i25.3918
  2. Khan KM. Endoscopic management of stricture in pediatrics. Tech Gastro Endosc 2013;15:25-31. https://doi.org/10.1016/j.tgie.2012.10.002
  3. Abreu M, Nunes I, Corujeira S, Tavares M, Trindade E, Dias JA. Caustic esophageal stenosis: a case report of endoscopic dilation with a dynamic stent. GE Port J Gastroenterol 2016;23:218-23. https://doi.org/10.1016/j.jpge.2015.12.006
  4. Wang H, Tan L, Feng M, Zhang Y, Wang Q. Comparison of the short-term health-related quality of life in patients with esophageal cancer with different routes of gastric tube reconstruction after minimally invasive esophagectomy. Qual Life Res 2011;20:179-89. https://doi.org/10.1007/s11136-010-9742-1
  5. Berger M, Ure B, Lacher M. Mitomycin C in the therapy of recurrent esophageal strictures: hype or hope? Eur J Pediatr Surg 2012;22:109-16. https://doi.org/10.1055/s-0032-1311695
  6. Lan LC, Wong KK, Lin SC, Sprigg A, Clarke S, Johnson PR, et al. Endoscopic balloon dilatation of esophageal strictures in infants and children: 17 years' experience and a literature review. J Pediatr Surg 2003;38:1712-5. https://doi.org/10.1016/j.jpedsurg.2003.08.040
  7. Li H, Liu Y, Shu XZ, Gray SD, Prestwich GD. Synthesis and biological evaluation of a cross-linked hyaluronan-mitomycin C hydrogel. Biomacromolecules 2004;5:895-902. https://doi.org/10.1021/bm034463j
  8. Noel RJ, Rothenberg ME. Eosinophilic esophagitis. Curr Opin Pediatr 2005;17:690-4. https://doi.org/10.1097/01.mop.0000184291.34654.be
  9. Pearson EG, Downey EC, Barnhart DC, Scaife ER, Rollins MD, Black RE, et al. Reflux esophageal stricture--a review of 30 years' experience in children. J Pediatr Surg 2010;45:2356-60. https://doi.org/10.1016/j.jpedsurg.2010.08.033
  10. Ali L, Shahzad M, Orakzai N, Khan I, Ahmad M. Efficacy of mitomycin C in reducing recurrence of anterior urethral stricture after internal optical urethrotomy. Korean J Urol 2015;56:650-5. https://doi.org/10.4111/kju.2015.56.9.650
  11. El-Serag HB. Temporal trends in new and recurrent esophageal strictures in Department of Veterans Affairs. Am J Gastroenterol 2006; 101:1727-33. https://doi.org/10.1111/j.1572-0241.2006.00618.x
  12. Spechler SJ, Lee E, Ahnen D, Goyal RK, Hirano I, Ramirez F, et al. Long-term outcome of medical and surgical therapies for gastroesophageal reflux disease: follow-up of a randomized controlled trial. JAMA 2001;285:2331-8. https://doi.org/10.1001/jama.285.18.2331
  13. Heran MK, Baird R, Blair GK, Skarsgard ED. Topical mitomycin-C for recalcitrant esophageal strictures: a novel endoscopic/fluoroscopic technique for safe endoluminal delivery. J Pediatr Surg 2008;43:815-8. https://doi.org/10.1016/j.jpedsurg.2007.12.017
  14. Rosseneu S, Afzal N, Yerushalmi B, Ibarguen-Secchia E, Lewindon P, Cameron D, et al. Topical application of mitomycin-C in oesophageal strictures. J Pediatr Gastroenterol Nutr 2007;44:336-41. https://doi.org/10.1097/MPG.0b013e31802c6e45
  15. Gusmon-Oliveira CC, Kuboki YM, de Paulo GA, de Lima MS, Uemura RS, Martins BC, et al. Endoscopic injection of mitomycin C for the treatment of pharyngoesophageal stenosis refractory to endoscopic treatment with dilatation in patients treated for head and neck cancer. Gastroenterol Res Pract 2018;2018:5428157. https://doi.org/10.1155/2018/5428157