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
