Treatment of Refractory Gastrointestinal Strictures With Mitomycin C

Rustagi, Tarun; Aslanian, Harry R.; Laine, Loren

doi:10.1097/mcg.0000000000000295

Cited by 25 publications

(14 citation statements)

References 58 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The majority of the publications (17 studies) enrolled only pediatric patients, corresponding to 70% of them. The most common etiology was caustic injury, with just 18% of the patients with anastomotic stricture and only 2 adult patients with radiation stricture [ 14 ]. Overall, 94% of 117 patients (pediatric and adults) included had a good response.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Injection of Mitomycin C for the Treatment of Pharyngoesophageal Stenosis Refractory to Endoscopic Treatment with Dilatation in Patients Treated for Head and Neck Cancer

Gusmon-Oliveira

Kuboki

Paulo

et al. 2018

Gastroenterology Research and Practice

View full text Add to dashboard Cite

Background Management of pharyngoesophageal stenosis (PES) in patients after head and neck cancer (HNC) treatment remains a challenge. It is not uncommon that PES is refractory to dilation sessions. This study aimed at evaluating the efficacy of Mitomycin C (MMC) endoscopic injection for the treatment of refractory pharyngoesophageal stenosis. Patients and methods This is a prospective study in patients with dysphagia following head and neck cancer treatment, without evidence suggestive of tumor recurrence, and refractory to endoscopic treatment. These patients were submitted to endoscopic dilation of the stenotic segment with thermoplastic bougies, followed by injection of MMC. We repeated the endoscopic sessions every three weeks. Results From January 2015 to May 2015, we treated 13 patients with PES. Three patients were initially enrolled in the study for refractory stricture. We observed adverse events in all of them, with intense neck pain and ulcer development, justifying the interruption of the trial. Conclusion The repeated injection in the short interval of MMC in refractory PES is not recommended, because it resulted in serious adverse events.

show abstract

Section: Discussionmentioning

confidence: 99%

Endoscopic Injection of Mitomycin C for the Treatment of Pharyngoesophageal Stenosis Refractory to Endoscopic Treatment with Dilatation in Patients Treated for Head and Neck Cancer

Gusmon-Oliveira

Kuboki

Paulo

et al. 2018

Gastroenterology Research and Practice

View full text Add to dashboard Cite

show abstract

“…30 A systematic review of Mitomycin C use in adults and children reported a complete response to therapy in 73% and a partial response in 21% though these uncontrolled data must be interpreted with considerable caution. 31 Other drugs There is the potential for multiple other drug applications to inhibit fibrosis but none have been evaluated in oesophageal stricturing. The process of fibrosis is complex but increasingly well understood.…”

Section: Steroid Injectionmentioning

confidence: 99%

Endoscopic management of refractory benign oesophageal strictures

Everett

2019

Clin Med Insights Gastroenterol

View full text Add to dashboard Cite

Refractory benign oesophageal strictures are an infrequent presentation but a cause of significant morbidity and mortality. The treatment of these strictures has changed little in recent years, yet new evidence is emerging for the optimal timing and application of different therapies. In this article, we have carefully reviewed the current literature on the evaluation and management of refractory strictures and provided practical advice as to their management. A number of areas require attention in future research, including carefully designed randomised trials of endoscopic and medical therapies, and a focus on risk factors at a patient and molecular level to facilitate development of medical therapies that can reduce recurrent fibrosis in these patients.

show abstract

“…The number of MMC applications varied between 1 and 12 with a mean of 2 and 2.6 in pediatric and adult patients, respectively, although the majority [67 children (79%) and 24 adults (63%)] required only 1 to 2 applications. When MMC was applied more than once, intervals ranged from 1 week to 13 months, with a median of 4 weeks (84). To date, no study compares the effectiveness of different concentrations and dosages of MMC; the concentration of 0.4 mg/mL is the most commonly used and appears to be effective.…”

Section: Treatmentmentioning

confidence: 99%

“…Most data on MMC efficacy in treating persistent esophageal stricture are coming from studies involving patients with caustic esophageal injury (79, 84). …”

Section: Treatmentmentioning

confidence: 99%

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

et al. 2017

View full text Add to dashboard Cite

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.

show abstract

Treatment of Refractory Gastrointestinal Strictures With Mitomycin C

Cited by 25 publications

References 58 publications

Endoscopic Injection of Mitomycin C for the Treatment of Pharyngoesophageal Stenosis Refractory to Endoscopic Treatment with Dilatation in Patients Treated for Head and Neck Cancer

Endoscopic Injection of Mitomycin C for the Treatment of Pharyngoesophageal Stenosis Refractory to Endoscopic Treatment with Dilatation in Patients Treated for Head and Neck Cancer

Endoscopic management of refractory benign oesophageal strictures

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

Contact Info

Product

Resources

About