Topical Mitomycin‐C Application in Recurrent Esophageal Strictures After Surgical Repair of Esophageal Atresia

Chapuy, Laurence; Pomerleau, Martine; Fauré, Christophe

doi:10.1097/mpg.0000000000000352

Cited by 35 publications

(34 citation statements)

References 19 publications

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“…On the contrary, a series of studies have shown the beneficial effects of mitomycin C on caustic esophageal strictures and anastomotic strictures after surgical repair of the esophageal atresia in children, in which a cotton pledget containing the drug is inserted into the esophagus or mitomycin C is injected via catheter balloon. However, most of these studies were small in sample size or lacked a control group …”

Section: Discussionmentioning

confidence: 99%

“…Mitomycin C is a chemotherapeutic agent that reduces the formation of scar when applied to surgical lesions. It has been widely used in children experience postoperative esophageal strictures who have undergone surgical repairs for esophageal atresia or those who have caustic esophageal strictures . In recent studies, mitomycin C has also been used for the treatment of esophageal strictures after ESD in adults .…”

Section: Introductionmentioning

confidence: 99%

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Intramuscular injection of mitomycin C combined with endoscopic dilation for benign esophageal strictures

Zhang

Wang

Liu

et al. 2015

J of Digest Diseases

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intramuscular injection of mitomycin C combined with endoscopic dilation for benign esophageal strictures

Zhang

Wang

Liu

et al. 2015

J of Digest Diseases

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“…Local injection of steroids[81] [82] and topical application of Mitomycin-C into the stricture site[83] have showed encouraging results, but long-term studies are needed to prove their efficacy and safety. Esophageal stenting (plastic or metal stents) has been reported to be effective in preventing stricture recurrence,[84, 85] [86] but additional evidence is required to confirm these data.…”

Section: Anastomotic Stricturesmentioning

confidence: 99%

How to Care for Patients with EA-TEF: The Known and the Unknown

Mousa

Krishnan

Hassan

et al. 2017

Curr Gastroenterol Rep

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EA patients are at high risk for gastroesophageal reflux and esophageal strictures, and the sequela that result. Extraintestinal manifestations of gastroesophageal reflux disease (GERD) can appear similar to other pathologic diagnoses commonly found in EA patients, such as congenital stricture, eosinophilic esophagitis, esophageal dysmotility, tracheomalacia, recurrent fistula, aspiration, etc. Therefore, it is important to have a standardized way to monitor for these issues. pH impedance allows for detection of nonacid reflux and the height of reflux, which are important in correlating symptoms with reflux episodes. A multidisciplinary approach is beneficial in evaluating and monitoring EA patients in the long term.

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“…Furthermore, the median number of dilations, although not statistically significant, was smaller in the historical cohort than in the MMC group [3.7 (range 3–7) and 5.4 (range 3–11), respectively]. Author concluded that in EA children adjuvant MMC treatment does not confer a real benefit compared with repeated dilations alone (86). …”

Section: Treatmentmentioning

confidence: 99%

Anastomotic Strictures after Esophageal Atresia Repair: Incidence, Investigations, and Management, Including Treatment of Refractory and Recurrent Strictures

et al. 2017

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Improved surgical techniques, as well as preoperative and postoperative care, have dramatically changed survival of children with esophageal atresia (EA) over the last decades. Nowadays, we are increasingly seeing EA patients experiencing significant short- and long-term gastrointestinal morbidities. Anastomotic stricture (AS) is the most common complication following operative repair. An esophageal stricture is defined as an intrinsic luminal narrowing in a clinically symptomatic patient, but no symptoms are sensitive or specific enough to diagnose an AS. This review aims to provide a comprehensive view of AS in EA children. Given the lack of evidence-based data, we critically analyzed significant studies on children and adults, including comments on benign strictures with other etiologies. Despite there is no consensus about the goal of the luminal diameter based on the patient’s age, esophageal contrast study, and/or endoscopy are recommended to assess the degree of the narrowing. A high variability in incidence of ASs is reported in literature, depending on different definitions of AS and on a great number of pre-, intra-, and postoperative risk factor influencing the anastomosis outcome. The presence of a long gap between the two esophageal ends, with consequent anastomotic tension, is determinant for stricture formation and its response to treatment. The cornerstone of treatment is endoscopic dilation, whose primary aims are to achieve symptom relief, allow age-appropriate capacity for oral feeding, and reduce the risk of pulmonary aspiration. No clear advantage of either balloon or bougie dilator has been demonstrated; therefore, the choice is based on operator experience and comfort with the equipment. Retrospective evidences suggest that selective dilatations (performed only in symptomatic patients) results in significantly less number of dilatation sessions than routine dilations (performed to prevent symptoms) with equal long-term outcomes. The response to dilation treatment is variable, and some patients may experience recurrent and refractory ASs. Adjunctive treatments have been used, including local injection of steroids, topical application of mitomycin C, and esophageal stenting, but long-term studies are needed to prove their efficacy and safety. Stricture resection or esophageal replacement with an interposition graft remains options for AS refractory to conservative treatments.

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Topical Mitomycin‐C Application in Recurrent Esophageal Strictures After Surgical Repair of Esophageal Atresia

Abstract: There is no benefit in the resolution of the stricture when adding mitomycin-C treatment compared with repeated esophageal dilations alone in historical controls. Further randomized controlled studies and a short- and long-term evaluation of safety are needed.

Cited by 35 publications

References 19 publications

Intramuscular injection of mitomycin C combined with endoscopic dilation for benign esophageal strictures

Intramuscular injection of mitomycin C combined with endoscopic dilation for benign esophageal strictures

How to Care for Patients with EA-TEF: The Known and the Unknown

Anastomotic Strictures after Esophageal Atresia Repair: Incidence, Investigations, and Management, Including Treatment of Refractory and Recurrent Strictures

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