Uhlen S, Fayoux P, Vachin F, Guimber D, Gottrand F, Turck D, Michaud L
Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University Hospital and Faculty of Medicine, Lille, France.
Endoscopy. 2006 Apr;38(4):404-7. doi: 10.1055/s-2006-925054. Epub 2006 Feb 3.
Mitomycin C is an antiproliferative agent that has been used successfully as an adjunct treatment in ophthalmological procedures, in the management of laryngeal and tracheal stenosis, and more recently to prevent the recurrence of caustic esophageal strictures in children. The aim of this study was to assess the efficacy and safety of local application of mitomycin C to refractory esophageal strictures in children.
We performed a preliminary prospective study of local application of mitomycin C in four children, aged between 1 year and 6 years, who had refractory esophageal strictures. Two of the children presented with strictures caused by caustic ingestion and the other two children had anastomotic strictures following surgical repair of congenital esophageal atresia. The patients had required between four and ten esophageal dilations over a 5-24-month period before mitomycin C application. After an endoscopic dilation, mitomycin C was applied onto the dilation wound using a rigid endoscope.
No complications were observed after the procedure. One child required a second application of mitomycin C 2 weeks after the first application because of recurrence of dysphagia. All the children remained asymptomatic and none of them required further dilation over a mean follow-up period of 24 months. Radiological control examinations revealed that there was no recurrence of the esophageal strictures and esophageal biopsies performed during follow-up showed no signs of dysplasia.
Local application of mitomycin C is a potential alternative to iterative dilations, surgery, or stent placement for the treatment of refractory esophageal strictures in children. However, prospective, long-term assessment of outcomes is needed before any definitive conclusion can be drawn about the usefulness of mitomycin C in these patients.
丝裂霉素C是一种抗增殖剂，已成功用作眼科手术的辅助治疗药物，用于治疗喉和气管狭窄，最近还用于预防儿童腐蚀性食管狭窄的复发。本研究的目的是评估局部应用丝裂霉素C治疗儿童难治性食管狭窄的疗效和安全性。
我们对4名年龄在1岁至6岁之间患有难治性食管狭窄的儿童进行了丝裂霉素C局部应用的初步前瞻性研究。其中2名儿童因吞服腐蚀性物质导致食管狭窄，另外2名儿童在先天性食管闭锁手术修复后出现吻合口狭窄。在应用丝裂霉素C之前的5至24个月期间，这些患者需要进行4至10次食管扩张。在内镜扩张后，使用硬式内镜将丝裂霉素C涂抹在扩张伤口上。
术后未观察到并发症。1名儿童因吞咽困难复发，在首次应用丝裂霉素C 2周后需要再次应用。所有儿童均无症状，在平均24个月的随访期内均无需进一步扩张。影像学对照检查显示食管狭窄未复发，随访期间进行的食管活检未显示发育异常迹象。
局部应用丝裂霉素C可能是治疗儿童难治性食管狭窄的反复扩张、手术或置入支架的替代方法。然而，在对丝裂霉素C在这些患者中的有效性得出任何明确结论之前，需要对结果进行前瞻性、长期评估。
