Efficacy and Safety of the Local Application of Mitomycin C to Recurrent Esophageal Strictures in Children

J Pediatr Gastroenterol Nutr. 2019 Nov;69(5):528-532. doi: 10.1097/MPG.0000000000002445.

Abstract

Objectives: Research on long-term use of mitomycin C (MC) for recurrent esophageal stenoses is limited. We assessed the long-term efficacy and safety of local application of MC for recurrent esophageal stenoses in children.

Methods: This was a retrospective study of 39 patients (17 girls) with a median age of 19.5 months (range: 2.4-196.0) at the time of MC application. The etiologies of stenosis were esophageal atresia (n = 25), caustic ingestion (n = 9), congenital esophageal stenosis (n = 3), and other causes (n = 2). Stenosis was single in 35 (90%) patients and multiple in 4 (10%). Before MC, patients underwent multiple repeated dilations (median: 3 dilations per child [range: 2-26]) over a median period of 7 months (range: 2.6-49.3). Treatment success was defined a priori as a reduction in the number of dilations over the same period from before to after the application of MC.

Results: For 26 (67%) patients, the application of MC was considered a success: 102 versus 17 dilatations (P < 0.0001). Sixteen (41%) patients never required additional dilation during the follow-up after MC application (median: 3.1 years [range: 0.6-8.5]). No complication related to MC was observed. Biopsies at the site of MC application were performed at maximal follow-up in 16 patients and revealed no dysplasia. Three factors were associated with success of MC: single stenosis, short stenosis, and esophageal atresia type III.

Conclusions: This study is the largest series reported showing that topical application of MC is an efficient and safe treatment for recurrent esophageal stenosis in children.

MeSH terms

  • Administration, Mucosal
  • Adolescent
  • Antibiotics, Antineoplastic / administration & dosage
  • Antibiotics, Antineoplastic / adverse effects
  • Antibiotics, Antineoplastic / therapeutic use*
  • Child
  • Child, Preschool
  • Esophageal Stenosis / drug therapy*
  • Esophagoscopy
  • Female
  • Humans
  • Infant
  • Male
  • Mitomycin / administration & dosage
  • Mitomycin / adverse effects
  • Mitomycin / therapeutic use*
  • Postoperative Complications
  • Retrospective Studies

Substances

  • Antibiotics, Antineoplastic
  • Mitomycin