Efficacy and safety of the local application of mitomycin C to recurrent oesophageal strictures in children.

Abstract

OBJECTIVES Research on long-term use of mitomycin C (MC) for recurrent oesophageal stenoses is limited. We assessed the long-term efficacy and safety of local application of MC for recurrent oesophageal stenoses in children. METHODS This was a retrospective study of 39 patients (17 girls) with a median age of 19.5 months (range: 2.4-196.0) at the time of MC application. The aetiologies of stenosis were oesophageal atresia (n = 25), caustic ingestion (n = 9), congenital oesophageal stenosis (n = 3), and other causes (n = 2). Stenosis was single in 35 (90%) patients and multiple in 4 (10%). Before MC, patients underwent multiple repeated dilations (median: 3 dilations per child (range: 2-26)) over a median period of 7 months (range: 2.6-49.3). Treatment success was defined a priori as a reduction in the number of dilations over the same period from before to after the application of MC. RESULTS For 26 (67%) patients, the application of MC was considered a success: 102 versus 17 dilatations (P < 0.0001). Sixteen (41%) patients never required additional dilation during the follow-up after MC application (median: 3.1 years (range: 0.6-8.5)). No complication related to MC was observed. Biopsies at the site of MC application were performed at maximal follow-up in 16 patients and revealed no dysplasia. Three factors were associated with success of MC: single stenosis, short stenosis, and oesophageal atresia type III. CONCLUSIONS This study is the largest series reported showing that topical application of MC is an efficient and safe treatment for recurrent oesophageal stenosis in children.