Mitomycin C application in resistant caustic esophageal stricture

Abstract

Background/purpose Caustic esophageal strictures still represent a catastrophic problem in children of our country. Management protocol is usually started by regular esophageal dilatation in which multiple sessions may be needed until the resolution of dysphagia; however, in many cases endoscopic dilatation fails and therefore esophageal replacement is eventually required. Our aim is to assess the role of mitomycin C application in the management of caustic esophageal stricture refractory to regular endoscopic dilatation.
Patients and methods Patients with resistant caustic esophageal stricture were subjected to topical mitomycin C application on stricture site after endoscopic dilatation. Patients were followed up clinically using validated dysphagia score to assess the improvement of dysphagia, radiologically by contrast esophagogram and endoscopically to confirm resolution of the stricture. Results were analyzed and compared with results of a control group managed at the institution by a regular dilatation protocol.
Results During the period January 2008 to June 2010, 12 patients with resistant caustic esophageal stricture were followed at our unit of whom six had a short esophageal stricture (< 3 cm) and six had a long stricture ( >3 cm). Topical mitomycin C application resulted in clinical and radiological resolution of dysphagia and strictures in 83% and 66% respectively, compared with 44 (eight out of 18 patients with short stricture) and 25% (two out of eight patients with long stricture) in the control group.
Conclusion Mitomycin C application can markedly improve the outcome of patients with caustic esophageal stricture, reducing the number of required sessions for endoscopic dilatation. However, double-blinded randomized controlled trial is needed to prove its effectiveness.

Keywords: caustic esophageal stricture, esophageal dilatation, mitomycin C