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DOI: 10.1055/s-0032-1311695
Mitomycin C in the Therapy of Recurrent Esophageal Strictures: Hype or Hope?
Publication History
24 February 2012
13 March 2012
Publication Date:
19 April 2012 (online)
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Abstract
Introduction Esophageal strictures refractory to conservative treatment represent a major problem in children. The application of Mitomycin C to the site of stricture has been introduced, but the experience with this novel approach remains very limited.
Methods Systematic review of publications on the topical application of Mitomycin C in children with persistent esophageal stricture.
Results We identified 11 publications including 31 cases. The underlying cause of stricture was caustic ingestion in 19 (61.2%), esophageal surgery in 7 (22.6%), and others in 5 children (16.2%). The median age of the patients was 48 months (range 4 to 276 months). In the majority of cases cotton pledgets soaked in solution of Mitomycin C were applied endoscopically. Various other techniques such as drug-eluting stents were used. Mitomycin C was applied from 1 to 12 times within intervals from 1 to 12 weeks. The concentrations of Mitomycin C varied considerably between 0.1 and 1 mg/mL. After a mean follow-up time of 22 (6 to 60) months complete relief of symptoms was reported for 21 children (67.7%), and 6 (19.4%) had a partial relief. In four children (12.9%) Mitomycin C treatment failed. No direct or indirect adverse effects were reported.
Conclusion The short-term results of topical Mitomycin C application for refractory esophageal stricture reported in the literature are very encouraging. Prospective studies are mandatory to determine the optimal time points, dosage, and modalities of treatment before a recommendation can be given.
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References
- 1 Lacher M, Froehlich S, von Schweinitz D. Early and long term outcome in children with esophageal atresia treated over the last 22 years. Klin Padiatr 2010; 222 (5) 296-301
- 2 Serhal L, Gottrand F, Sfeir R , et al. Anastomotic stricture after surgical repair of esophageal atresia: frequency, risk factors, and efficacy of esophageal bougie dilatations. J Pediatr Surg 2010; 45 (7) 1459-1462
- 3 Chittmittrapap S, Spitz L, Kiely EM, Brereton RJ. Anastomotic stricture following repair of esophageal atresia. J Pediatr Surg 1990; 25 (5) 508-511
- 4 Broor SL, Raju GS, Bose PP , et al. Long term results of endoscopic dilatation for corrosive oesophageal strictures. Gut 1993; 34 (11) 1498-1501
- 5 Saleem MM. Acquired oesophageal strictures in children: emphasis on the use of string-guided dilatations. Singapore Med J 2009; 50 (1) 82-86
- 6 Michaud L, Gottrand F. Anastomotic strictures: conservative treatment. J Pediatr Gastroenterol Nutr 2011; 52 (Suppl. 01) S18-S19
- 7 Hishiki T, Kouchi K, Saito T , et al. Successful treatment of severe refractory anastomotic stricture in an infant after esophageal atresia repair by endoscopic balloon dilation combined with systemic administration of dexamethasone. Pediatr Surg Int 2009; 25 (6) 531-533
- 8 Zein NN, Greseth JM, Perrault J. Endoscopic intralesional steroid injections in the management of refractory esophageal strictures. Gastrointest Endosc 1995; 41 (6) 596-598
- 9 Lee M, Kubik CM, Polhamus CD, Brady III CE, Kadakia SC. Preliminary experience with endoscopic intralesional steroid injection therapy for refractory upper gastrointestinal strictures. Gastrointest Endosc 1995; 41 (6) 598-601
- 10 Altintas E, Kacar S, Tunc B , et al. Intralesional steroid injection in benign esophageal strictures resistant to bougie dilation. J Gastroenterol Hepatol 2004; 19 (12) 1388-1391
- 11 Kochhar R, Makharia GK. Usefulness of intralesional triamcinolone in treatment of benign esophageal strictures. Gastrointest Endosc 2002; 56 (6) 829-834
- 12 Miyashita M, Onda M, Okawa K , et al. Endoscopic dexamethasone injection following balloon dilatation of anastomotic stricture after esophagogastrostomy. Am J Surg 1997; 174 (4) 442-444
- 13 Shah JN. Benign refractory esophageal strictures: widening the endoscopist's role. Gastrointest Endosc 2006; 63 (1) 164-167
- 14 Morikawa N, Honna T, Kuroda T , et al. High dose intravenous methylprednisolone resolves esophageal stricture resistant to balloon dilatation with intralesional injection of dexamethasone. Pediatr Surg Int 2008; 24 (10) 1161-1164
- 15 Coopman S, Michaud L, Halna-Tamine M , et al. Long-term outcome of colon interposition after esophagectomy in children. J Pediatr Gastroenterol Nutr 2008; 47 (4) 458-462
- 16 Burgos L, Barrena S, Andrés AM , et al. Colonic interposition for esophageal replacement in children remains a good choice: 33-year median follow-up of 65 patients. J Pediatr Surg 2010; 45 (2) 341-345
- 17 Afzal NA, Albert D, Thomas AL, Thomson M. A child with oesophageal strictures. Lancet 2002; 359 (9311) 1032
- 18 Uhlen S, Fayoux P, Vachin F , et al. Mitomycin C: an alternative conservative treatment for refractory esophageal stricture in children?. Endoscopy 2006; 38 (4) 404-407
- 19 Rosseneu S, Afzal N, Yerushalmi B , et al. Topical application of mitomycin-C in oesophageal strictures. J Pediatr Gastroenterol Nutr 2007; 44 (3) 336-341
- 20 Begleiter A. Clinical applications of quinone-containing alkylating agents. Front Biosci 2000; 5: E153-E171
- 21 Caron RM, Hamilton JW. Preferential effects of the chemotherapeutic DNA crosslinking agent mitomycin C on inducible gene expression in vivo. Environ Mol Mutagen 1995; 25 (1) 4-11
- 22 Gray SD, Tritle N, Li W. The effect of mitomycin on extracellular matrix proteins in a rat wound model. Laryngoscope 2003; 113 (2) 237-242
- 23 Kao SC, Liao CL, Tseng JH, Chen MS, Hou PK. Dacryocystorhinostomy with intraoperative mitomycin C. Ophthalmology 1997; 104 (1) 86-91
- 24 Wilkins M, Indar A, Wormald R. Intra-operative mitomycin C for glaucoma surgery. Cochrane Database Syst Rev 2005; 4 (4) CD002897
- 25 Penttilä E, Smirnov G, Seppä J, Kaarniranta K, Tuomilehto H. Mitomycin C in revision endoscopic dacryocystorhinostomy: a prospective randomized study. Am J Rhinol Allergy 2011; 25 (6) 425-428
- 26 Rahbar R, Shapshay SM, Healy GB. Mitomycin: effects on laryngeal and tracheal stenosis, benefits, and complications. Ann Otol Rhinol Laryngol 2001; 110 (1) 1-6
- 27 Rahbar R, Valdez TA, Shapshay SM. Preliminary results of intraoperative mitomycin-C in the treatment and prevention of glottic and subglottic stenosis. J Voice 2000; 14 (2) 282-286
- 28 Rahbar R, Jones DT, Nuss RC , et al. The role of mitomycin in the prevention and treatment of scar formation in the pediatric aerodigestive tract: friend or foe?. Arch Otolaryngol Head Neck Surg 2002; 128 (4) 401-406
- 29 Chung JH, Cosenza MJ, Rahbar R, Metson RB. Mitomycin C for the prevention of adhesion formation after endoscopic sinus surgery: a randomized, controlled study. Otolaryngol Head Neck Surg 2002; 126 (5) 468-474
- 30 Karkos PD, Leong SC, Sastry A, Assimakopoulos AD, Swift AC. Evidence-based applications of mitomycin C in the nose. Am J Otolaryngol 2011; 32 (5) 422-425
- 31 Annino Jr DJ, Goguen LA. Mitomycin C for the treatment of pharyngoesophageal stricture after total laryngopharyngectomy and microvascular free tissue reconstruction. Laryngoscope 2003; 113 (9) 1499-1502
- 32 Daher P, Riachy E, Georges B, Georges D, Adib M. Topical application of mitomycin C in the treatment of esophageal and tracheobronchial stricture: a report of 2 cases. J Pediatr Surg 2007; 42 (9) E9-E11
- 33 Senturk E, Pabuscu E, Sen S, Unsal C. Comparison of mitomycin-c and heparin affects in experimental corrosive esophagitis on rats. Int J Pediatr Otorhinolaryngol 2011; 75 (6) 785-789
- 34 Türkyilmaz Z, Sönmez K, Karabulut R , et al. Mitomycin C decreases the rate of stricture formation in caustic esophageal burns in rats. Surgery 2009; 145 (2) 219-225
- 35 Türkyilmaz Z, Sönmez K, Demirtola A , et al. Mitomycin C prevents strictures in caustic esophageal burns in rats. J Surg Res 2005; 123 (2) 182-187
- 36 Heran MKS, Pham TH, Butterworth S, Robinson A. Use of a microporous polytetrafluoroethylene catheter balloon to treat refractory esophageal stricture: a novel technique for delivery of mitomycin C. J Pediatr Surg 2011; 46 (4) 776-779
- 37 Broto J, Gil-Vernet JM, Royo G, Cabañas MJ. [Use of mitomycin C in esophageal stenosis]. Cirugía Pediátrica 2007; 20 (1) 57-58
- 38 Olutoye OO, Shulman RJ, Cotton RT. Mitomycin C in the management of pediatric caustic esophageal strictures: a case report. J Pediatr Surg 2006; 41 (5) e1-e3
- 39 Fröhlich T, Greess H, Köhler H. [Topical mitomycin C treatment of a benign oesophageal stricture following caustic ingestion in a four-year-old boy]. Z Gastroenterol 2007; 45 (3) 255-258
- 40 Heran MKS, 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 (5) 815-818
- 41 Chung J, Connolly B, Langer J, Marcon M, Temple M, Amaral JG. Fluoroscopy-guided topical application of mitomycin-C in a case of refractory esophageal stricture. J Vasc Interv Radiol 2010; 21 (1) 152-155
- 42 Spier BJ, Sawma VA, Gopal DV, Reichelderfer M. Intralesional mitomycin C: successful treatment for benign recalcitrant esophageal stricture. Gastrointest Endosc 2009; 69 (1) 152-153 , discussion 153
- 43 Broor SL, Lahoti D. Balloon dilation of corrosive esophageal strictures. Gastrointest Endosc 1993; 39 (4) 597-598
- 44 Broor SL, Lahoti D, Bose PP, Ramesh GN, Raju GS, Kumar A. Benign esophageal strictures in children and adolescents: etiology, clinical profile, and results of endoscopic dilation. Gastrointest Endosc 1996; 43 (5) 474-477
- 45 Ko HK, Shin JH, Song HY , et al. Balloon dilation of anastomotic strictures secondary to surgical repair of esophageal atresia in a pediatric population: long-term results. J Vasc Interv Radiol 2006; 17 (8) 1327-1333