Prospective study of the effect of topical application of Mitomycin C in refractory pediatric caustic esophageal strictures

Abstract

Cure rate was double in the MMC group. MMC application significantly improved symptoms and reduced both the number and frequency of dilatations to alleviate dysphagia in patients with refractory caustic esophageal strictures and hence reduced the cost of treatment.

Successful treatment of a dog with recurrent nasopharyngeal stenosis using balloon dilation and a novel topical mitomycin delivery system

“…Mitomycin reduces scar tissue formation by disrupting DNA base pairing, preventing RNA and protein synthesis, inhibiting fibroblast proliferation and inducing fibroblast apoptosis 13. A combination of bougienage and topical mitomycin has been used successfully to reduce or prevent reformation of strictures and stenosis of the anus,14 oesophagus,15 16 upper airway9 17 18 and urethra in people,18 and experimentally in dogs to prevent anterior glottis stenosis after vocal fold strippping 11. There are no prospective studies comparing topical mitomycin application duration, interval, or frequency or drug concentrations 13 17.…”

“…The best interval for retreatment with bougienage and mitomycin is not known; in a study of children with chronic, extensive, refractory oesophageal strictures, successive treatments were performed at two‐week intervals 16. In the dog reported herein, the second mitomycin infusion was performed one week after the first because of previous rapid recurrence of clinical signs and, as a cost saving measure, so that mitomycin remaining from the initial treatment could be used if needed.…”

Efficacy of Endoscopic Topical Mitomycin C Application in Caustic Esophageal Strictures in the Pediatric Population: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…Sweed et al (12) -used the score suggested by Earlam and Cunha-Melo (1981) (13) . El-Asmar et al (14) -and Ghobrial et al (15) -used the Dysphagia Scoring system. In the present study, complete resolution of dysphagia is referred to as the capacity to ingest any type of food (grade 1 -Earlam and Cunha-Melo; grade 0 -Dysphagia scoring system) -FIGURE 2.…”

“…The number of dilations performed both on resolved cases only and on all participating patients was reported as the mean and the standard deviation. The cost of treatment was assessed only in the study by Ghobrial et al (15) -who used mean and standard deviation in American dollars (US$), only for patients that presented with some degree of clinical or endoscopic improvement. Regarding complications, the authors assessed: local pain after the procedure, bleeding, and esophageal perforation.…”

“…Ghobrial et al (15) -topical application through a multi-porous spray catheter placed on the injury under direct visualization using a concentration of 0.4 mg/mL after an initial dilation. The initial schedule was for four applications within 2 weeks between them.…”