Madadi-Sanjani Omid, Zimmer Julia, Gosemann Jan-Hendrik, Ure Benno M, Lacher Martin, Boehm Roland
Center of Pediatric Surgery, Hannover Medical School, Hannover, Germany.
Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany.
Eur J Pediatr Surg. 2018 Dec;28(6):539-546. doi: 10.1055/s-0037-1615278. Epub 2017 Dec 21.
Recurrent esophageal strictures (ESs) following esophageal atresia repair or caustic ingestion represent a common clinical problem. Recently, Mitomycin C was reported to improve the outcome of patients by reducing the number of endoscopic dilatations. However, other groups failed to exhibit a beneficial effect. We report on our experience with topic Mitomycin C application following endoscopic dilatation for recurrent ES.
Retrospective chart review of patients with ES treated at the Hannover Medical School (Location A) and the University of Leipzig (Location B) between 2009 and 2015. A Mitomycin C-soaked cotton swab was endoscopically placed at the area of stricture in all subjects. Successful treatment was defined as resolution of stricture after Mitomycin C therapy with not more than three dilatations thereafter. Our results were compared with published outcomes of alternative studies that involved 10 or more patients.
A total of 11 children received Mitomycin C concurrently with endoscopic dilatations. Seven children (64%) had gross type C esophageal atresia, two patients (18%) gross type A esophageal atresia, and two children (18%) caustic injury.After a median follow-up of 34 months (range, 14-75 months) and a median number of 3 ± 2.5 dilatations with Mitomycin C application per patient (range, 1-9), 6 of 11 patients (55%) achieved a resolution of their strictures. Five patients (45%) did not respond to Mitomycin C therapy, of which two needed esophageal redo-surgery.
We failed to confirm the high success rates of Mitomycin C treatment for recurrent ESs. Given the fact that there is limited data to prove the beneficial effect of Mitomycin C treatment, pediatric surgeons should carefully consider whether the advantages of this therapy outweigh the necessity of life-long endoscopic follow-ups. Further randomized controlled studies are recommended.
食管闭锁修复术后或腐蚀性物质摄入后复发性食管狭窄（ES）是一个常见的临床问题。最近，有报道称丝裂霉素C可通过减少内镜扩张次数来改善患者的治疗效果。然而，其他研究组未能显示出有益效果。我们报告了内镜扩张治疗复发性ES后局部应用丝裂霉素C的经验。
对2009年至2015年在汉诺威医学院（A地）和莱比锡大学（B地）接受治疗的ES患者进行回顾性病历审查。所有受试者均在内镜下将浸有丝裂霉素C的棉拭子置于狭窄部位。成功治疗定义为丝裂霉素C治疗后狭窄解除，且此后扩张次数不超过3次。我们的结果与涉及10名或更多患者的其他研究的已发表结果进行了比较。
共有11名儿童在接受内镜扩张的同时接受了丝裂霉素C治疗。7名儿童（64%）为C型食管闭锁，2名患者（18%）为A型食管闭锁，2名儿童（18%）为腐蚀性损伤。中位随访34个月（范围14 - 75个月），每位患者应用丝裂霉素C时的扩张次数中位数为3±2.5次（范围1 - 9次），11名患者中有6名（55%）的狭窄得到解除。5名患者（45%）对丝裂霉素C治疗无反应，其中2名需要再次进行食管手术。
我们未能证实丝裂霉素C治疗复发性ES的高成功率。鉴于证明丝裂霉素C治疗有益效果的数据有限，小儿外科医生应仔细考虑这种治疗的优势是否超过终身内镜随访的必要性。建议进一步进行随机对照研究。
