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LACK OF EFFICACY OF TOPICAL MITOMYCIN-C APPLICATION IN REFRACTORY ESOPHAGEAL STRICTURES AFTER SURGICAL REPAIR OF ESOPHAGEAL ATRESIA
L Chapuy, M Pomerleau, P Perreault, C FaureDivision of Pediatric Gastroenterology, Sainte-Justine Hospital, Department of Pediatrics, Université de Montréal, Montreal, QC
Aims: There are only a few limited studies on esophageal strictures of various origins (caustic, peptic, postsurgical) that have suggested a role of mitomycin-C, an antifibrotic agent, in preventing secondary restricturing. The aim of this study was to specifically evaluate the efficacy of topical application of mitomycin-C in refractory anastomotic strictures occurring after surgical repair of esophageal atresia (EA).
Methods: We retrospectively reviewed the medical records of 12 patients suffering from esophageal stricture after surgery for EA (type C, n=8; type A, n=4), who underwent esophageal dilation and concomitant topical application of mitomycin-C (median age 12 months, range 2 months to 15 years). All patients received one or two applications of mitomycin-C except one who received six applications. Mitomycin-C was applied after the 1st dilation (n=2 patients), 2nd dilation (n=3), 3rd dilation (n=2), 4th dilation (n=4) and the 5th (n=1). The endpoints of the study were (i) the need for subsequent dilation following the first application of mitomycin-C and (ii) the resolution of dysphagia.
Results: With a median follow-up after the first application of mitomycin-C of 34 months (range 3 to 134 months), only two out of the 12 patients did not need subsequent dilation. For the remaining 10 patients, one to seven subsequent dilations were performed. Six of 10 patients finally experienced an improvement of their symptoms, after repeated dilations (median number of total dilations was 5, range 3 to 11). Four of 10 patients remained with dysphagia. No dysplasia related to mitomycin-C was demonstrated. One patient presented with a tracheoesophageal fistula at 10 months, after sixdilations (two with mitomycin-C).
Conclusions: In the setting of anastomotic esophageal strictures after surgery for EA, local application of mitomycin-C does not prevent restricturing nor improve dysphagia.