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Eur J Pediatr Surg 2012; 22(02): 109-116
DOI: 10.1055/s-0032-1311695
Review
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Mitomycin C in the Therapy of Recurrent Esophageal Strictures: Hype or Hope?

Michael Berger
1   Virgen del Rocío Children's Hospital, Seville, Spain
,
Benno Ure
2   Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
,
Martin Lacher
2   Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany
› Author Affiliations
Further Information

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.

Keywords

mitomycin C - esophageal stricture - esophageal stenosis - endoscopy - balloon dilation
 

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