Topical Application of Mitomycin‐C in Oesophageal Strictures

ABSTRACT Background: Benign oesophageal strictures may occur as a complication of caustic ingestion or severe gastro‐oesophageal reflux or as a sequela of oesophageal surgery and other fibrosing conditions. The traditional initial treatment of oesophageal strictures is intraluminal dilation; however, even if frequent, this occasionally may not provide adequate oesophageal lumen capacity or give significant symptom‐free intervals, and restricturing after dilation is difficult and challenging. Topical postdilation application of an antifibrotic agent, mitomycin‐C, in the treatment of an oesophageal stricture has been described. Patients and Methods: Eight centres participated, with a total of 16 patients (4 girls), median age 48 (range 0–276) months. The causes of stricture were as follows: caustic (10), post–trachea‐oesophageal fistula repair (2), peptic (2), Crohn disease (1), and dystrophic epidermolysis bullosa (1). The median (range) length and diameter of the strictures were as follows: 22 mm (8–50 mm) and 1.5 mm (1–6 mm). Of the 16 patients, 15 had undergone repeated dilations varying from 3 to more than 1000 (daily self‐bouginage) before mitomycin‐C, and the median interval between dilations was 4 weeks. Mitomycin‐C 0.1 mg/mL was applied after dilation for a median time of 3.5 minutes and a median of 3 (1–12) times. Results: Major success, both endoscopic and clinical improvement or cure, occurred in 10 of 16 patients. In 3 of 16 patients the interval period between dilations increased dramatically. Failure of therapy was considered in 3 of 16. All of the patients remained symptom free for a follow‐up time of as long as 5 years. Conclusions: Postdilation application of topical mitomycin‐C resulted in major success in 62.5% of patients and partial success in 19%, and it may be a useful strategy in oesophageal strictures of differing causes that are refractory to repeated perendoscopic dilation.