Mitomycin for recalcitrant strictures of the esophagus

Abstract

Purpose: This study is to demonstrate the utility of using mitomycin injections to relieve esophageal strictures when other methods failed. Methods: Mitomycin is a chemotherapeutic agent which inhibits the formation of fibroblasts. In this study the dose of mitomycin was small compared to the usual IV dose of 20 mg/m squared. Mitomycin in a dose of 1 or 2 mg was injected into recalcitrant benign esophageal strictures after balloon dilation. The injections were made with the sclerotherapy needle and infused on either side of the crack produced by the dilation. After instillation, the stricture was again balloon dilated in an effort to distribute the mitomycin into the tissues. Results: A 60 year old man had esophagectomy and gastric pull up for carcinoma of the esophagus. Post-operatively he developed an anastomotic stricture. In spite of balloon dilations, injection of methylprednisolone and a PPI he was requiring dilation every 3 weeks. After 4 sequential treatments with mitomycin between 1-22-09 and 6-18-09, he was able to go for a year without needing another. An 89 year-old-woman was requiring balloon dilation of her benign esophageal ring every 3 to 4 months in order to prevent meat impactions. She was treated with an injection of 2 mg of mitomycin into her stricture on 11-6-09. She has not required a repeat dilation since then. Conclusion: Injection of a 1-2 mg of mitomycin into recalcitrant benign strictures of the esophagus appears to lengthen the time between dilations necessary to avoid dysphagia.