Short‐term Effects of Mitomycin C Infiltration for Caustic Oesophageal Strictures in Children

Abstract

Objectives: The aim of this study was to investigate the efficacy and safety of endoscopic local infiltration of mitomycin C (MMC) after oesophageal dilation for children suffering from refractory postcorrosive oesophageal stricture (OS). Methods: Children referred to Cairo University Specialized Paediatric Hospital with refractory postcorrosive OS during the period from March 2016 to August 2017 were included in this study. MMC was infiltrated endoscopically at the stricture site by the end of the dilation session. The measured outcomes were dysphagia score (DS) and periodic dilation index (PDI). Results: During the inclusion period of the presented study, 17 children met the inclusion criteria. There were 7 boys and 10 girls. During the follow-up period, an average of 3.8 dilation sessions with MMC infiltration per case were performed, using a total dose of 1 mg each session. The median follow-up period was 9.5 months. The median DS improved from DS 3 before application of MMC to DS 0 at the last follow-up (P < 0.001). Additionally, the median PDI declined from 1 to 0.75 after MMC application (P = 0.052). Sixteen cases (94%) became dysphagia free after 6 months. Seven patients experienced postdilation minor bleeding that was spontaneously resolved, not triggering blood transfusion. There were no infiltration-related complications in the included series. Conclusion: Stricture-site MMC endoscopic infiltration by the end of a dilation session proved to be safe and effective in improving the DS and PDI.

Therapeutic Upper Gastrointestinal Endoscopy in Pediatric Gastroenterology

“…A French multicenter study showed a 67% success rate in their 39 patients with a significant decrease in number of dilatations prior (102) and post MMC application (17) (51). Wishahy et al observed a significant improvement in dysphagia score in their 17 children treated with MMC (54). In general, patients received an MMC dose between 0.1 and 1 mg/ml.…”

“…Various etiologies can cause esophageal strictures and stenosis in children, with caustic, anastomotic, congenital, GERD, and eosinophilic esophagitis being the most common (22,(49)(50)(51)(52)(53)(54). To date, there are various endoscopic treatment options, of which endoluminal balloon dilatation is probably the most useful and safe.…”

New therapies for esophageal strictures in children

“…Recently, intralesional administration of MMC was found to be effective and safe in 17 children with refractory caustic strictures in the short term [40].…”