Abstract
Background
Esophageal strictures resulting from caustic ingestion in children are usually difficult to be managed, and surgical replacement is usually required for cases refractory to frequent dilatation sessions. Topical Mitomycin C (MMC) has been recently used in the management of resistant strictures. We evaluated the efficacy of MMC application in treatment of long refractory caustic esophageal strictures.
Methods
This prospective study included 120 patients of both sexes with refractory caustic long esophageal strictures (> 3 cm in length). All patients were randomly divided into two equal groups using the research randomizer program (1:1 randomization), group I underwent endoscopic dilatation therapy only and group II underwent dilatation with topical application of MMC. Follow-up was done regularly by assessing the dysphagia score and patients were evaluated after 6 months of management. The procedure was repeated four times with 2-week intervals. Complete relieve of symptoms (dysphagia score = 0) was assessed after the follow-up period.
Results
The complete cure was detected in 81.6% of patients in the MMC group compared to only 40% in the first group, p-value < 0.0001. During the follow-up, the average sessions of dilatation needed in group II were 3.25 ± 2.78 compared to 6.25 ± 1.74 sessions in group I (p < 0.001). The mean cost of sessions in patients who showed symptomatic and endoscopic improvement was significantly lower in group II (272.2 ± 51 US$) when compared to group I (404 ± SD 55.7 US$).
Conclusions
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.
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Abbreviations
- F:
-
French
- MMC:
-
Mitomycin C
- SD:
-
Standard deviation
- $:
-
Dollar
References
Riffat F, Cheng A (2009) Pediatric caustic ingestion: 50 consecutive cases and a review of the literature. Dis Esophagus 22:89–94
Repici A, Vleggaar FP, Hassan C et al (2010) Efficacy and safety of biodegradable stents for refractory benign esophageal strictures: the BEST (Biodegradable Esophageal Stent) study. Gastrointest Endosc 72:927–934
Temiz A, Oguzkurt P, Ezer SS et al (2010) Long-term management of corrosive esophageal stricture with balloon dilation in children. Surg Endosc 24:2287–2292
Poddar U, Thapa BR (2001) Benign esophageal strictures in infants and children: results of Savary–Gilliard bougie dilation in 107 Indian children. Gastrointest Endosc 54:480–484
Repici A, Conio M, Angelis CD et al (2004) Temporary placement of an expandable polyester silicone-covered stent for treatment of refractory benign esophageal strictures. Gastrointest Endosc 60:513–519
Cheng Y, Li M, Yang R et al (2003) Restenosis following balloon dilation of benign esophageal stenosis. World J Gastroenterol 9:2605–2608
Uhlen S, Fayoux P, Vachin F et al (2006) Mitomycin C: an alternative conservative treatment for refractory esophageal stricture in children? Endoscopy 38:404–407
Rahbar R, Shapshay SM, Healy GB (2001) Mitomycin: effects on laryngeal and tracheal stenosis: benefits and complications. Ann Otol Rhinol Laryngol 110:1–6
Berger M, Ure B, Lacher M (2012) Mitomycin C in the therapy of recurrent esophageal strictures: hype or hope? Eur J Pediatr Surg 22:109–116
Sweed AS, Fawaz SA, Ezzat WF et al (2015) A prospective controlled study to assess the use of mitomycin C in improving the results of esophageal dilatation in post corrosive esophageal stricture in children. Int J Pediatr Otorhinolaryngol 79:23–25
El-Asmar KM, Hassan MA, Abdelkader HM et al (2013) Topical mitomycin C application is effective in management of localized caustic esophageal stricture: a double-blinded, randomized, placebo-controlled trial. J Pediatr Surg 48:1621–1627
El-Asmar KM, Hassan MA, Abdelkader HM et al (2015) Topical mitomycin C can effectively alleviate dysphagia in children with long-segment caustic esophageal strictures. Dis Esophagus 28:422–427
Chapuy L, Pomerleau M, Faure C (2014) Topical mitomycin-C application in recurrent esophageal strictures after surgical repair of esophageal atresia. J Pediatr Gastroenterol Nutr 59:608–611
Dall’Oglio L, Caldaro T, Foschia F et al (2016) Endoscopic management of esophageal stenosis in children: new and traditional treatments. World J Gastrointest Endosc 8:212–219
Hamza AF, Abdelhay S, Sherif H et al (2003) Caustic esophageal strictures in children: 30 years’ experience. J Pediatr Surg 38:828–833
Youn BJ, Kim WS, Cheon JE et al (2010) Balloon dilatation for corrosive esophageal strictures in children: radiologic and clinical outcomes. Korean J Radiol 11:203–210
Ubell ML, Ettema SL, Toohill RJ et al (2006) Mitomycin-c application in airway stenosis surgery: analysis of safety and costs. Otolaryngol Head Neck Surg 134:403–406
Iniguez-Cuadra R, San Martin Preito J, Iniguez-Cuadra M et al (2008) Effect of mitomycin in the surgical treatment of tracheal stenosis. Arch Otolaryngol Head Neck Surg 134:709–714
Amir M, Youssef T (2010) Congenital glottis web: management and anatomical observation. Clin Respir J 4:202–207
Türkyılmaz Z, Sönmez K, Demirtola A et al (2005) Mitomycin C prevents strictures in caustic esophageal burns in rats. J Surg Res 123:182–187
Heran MKS, Baird R, Blair GK et al (2008) Topical mitomycin-C for recalcitrant esophageal strictures: a novel endoscopic/fluoroscopic technique for safe endoluminal delivery. J Pediatr Surg 43:815–818
Chung J, Connolly B, Langer J et al (2010) Fluoroscopy-guided topical application of mitomycin-C in a case of refractory esophageal stricture. J Vasc Interv Radiol 21:152–155
Kumar A, Bhatnagar V (2005) Topical application of mitomycin-C in corrosive esophageal strictures. J Indian Assoc Pediatr Surg 10:25–27
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Dr. Carolyne Morcos Ibrahim Ghobrial carried out data collection and the initial analyses, statistical analysis, reviewed and revised the manuscript, and approved the final manuscript as submitted. Dr. Ayman Emil Eskander designed the data collection, and coordinated and supervised data collection, critically reviewed the manuscript, and approved the final manuscript as submitted.
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Dr. Carolyne Ghobrial and Prof. Ayman Eskander have indicated that they have no conflicts of interest to disclose and have no financial relationships relevant to this article to disclose.
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This study was approved by the Ethics Committee of the Departments of Pediatrics, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
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Ghobrial, C.M., Eskander, A.E. Prospective study of the effect of topical application of Mitomycin C in refractory pediatric caustic esophageal strictures. Surg Endosc 32, 4932–4938 (2018). https://doi.org/10.1007/s00464-018-6253-6
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DOI: https://doi.org/10.1007/s00464-018-6253-6