Background and Aims: The aim of this study was to evaluate the efficacy and short term safety of topical mitomycin-C, an antifibrotic agent, in preventing the recurrence of anastomotic strictures after surgical repair of esophageal atresia (EA).
Patients and Methods: We retrospectively reviewed the medical records of patients with recurrent anastomotic strictures after EA surgery who underwent at least 3 esophageal dilations. We compared the outcome (i.e. resolution of the stricture) of the group that received topical mitomycin-C treatment with endoscopic esophageal dilation to a historical cohort treated by dilations alone.
Results: Eleven children received mitomycin-C concurrently with endoscopic dilations. After a median follow-up of 33 months (range 18-72), and a mean number of 5.4 dilations/patient (range 3-11), 8 out of 11 patients achieved a resolution of their stricture, 2 patients remained with stenosis and 1 patient needed a surgical correction. In the control group, 10 patients required an average of 3.7 (range 3-7) total dilations. After a follow-up of 125 months (range 35-266) after the last dilation, 9 out of 10 children had a disappearance of their stricture and the remaining patient was symptom free. No dysplasia related to mitomycin-C was demonstrated.
Conclusion: There is no benefit in the resolution of the stricture when adding mitomycin-C treatment compared to repeated esophageal dilations alone in historical controls. Further randomized controlled studies are needed as well as a short and long term evaluation of safety.
(C) 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,