Mitomycin C for the Treatment of a Recalcitrant Esophageal Stricture

Abstract

Background: Mechanical dilation is the most common treatment method for esophageal stricture. Rarely, a stricture may be refractory to combination therapy to including dilation, intralesional steroid injection, and esophageal stent therapy, which are all fairly common treatments for esophageal strictures. In the past decade, mitomycin-C has gained popularity for its use in treating refractory esophageal strictures with promising results mostly in pediatric patients. Design: Case report and literature review. Case: We present a 63 years old patient with complicated, recalcitrant esophageal stricture that failed to improve with multiple mechanical dilations, steroid injection, repeated esophageal stenting, and needle knife incisional treatment. The patient had intermittent and temporary relief of dysphagia with these treatments, but the symptom-free duration fluctuated between 1-4 weeks and dramatically dropped to 1-2 weeks after a complicated metal stent placement at the end of 2014. For this recalcitrant stricture, low dose topical mitomycin-C with mechanical dilation was used with good response. Conclusion: Mitomycin-C is a safe and effective treatment option for recalcitrant esophageal strictures; however, further study is needed to determine long term effects of topical application as well as optimal dosage and scheduling for this medication.