Topical Application Of mitomycin-C Research Articles

Early topical mitomycin-C prevents stricture formation in children with caustic ingestion.

Stricture formation is the most common remote complication of caustic ingestion. The aim of this study was evaluation of the efficacy of early topical endoscopic application of mitomycin C (MMC) in prevention of stricture formation after corrosive ingestion in children. We enrolled 78 children with a history of caustic ingestion within 48 h in a prospective, randomised-controlled study. Only 61 children completed the study and were classified into two groups: group A and B. After initial stabilisation, patients in group A (n = 30) received topical application of MMC within the initial 48 h while patients in group B (n = 31) only received conventional management. Follow-up endoscopic dilatation was done every 2 weeks to patients in either group until no need for further dilatation. The barium study, which was done on the third week, revealed that all the patients (100%) on conservative management (group B) had strictures while only nine patients (30%) in group A had strictures (P < 0.001). The median number of dilatations required for patients in group B was 26 (min. = 23 and max. = 32) while in group A, it was 0 (min. = 0 and max. = 7) (P < 0.001). The success of early MMC application was complete response in 26 patients (86.7%), partial response in 3 patients (10%) and no response in 1 patient (3.3%). On the other side, conventional therapy with endoscopic dilatation achieved complete response in 11 patients (35.5%). Early topical MMC application proved its efficacy and safety in prevention of scar and stricture formation in children following caustic ingestion.

Simultaneous bilateral choanal and nasopharyngeal stenosis in an adult patient: case report and treatment approach

&lt;p class="abstract"&gt;Choanal and nasopharyngeal stenosis in adults are extremely rare. They usually are detected and treated in pediatric age as they typically result from congenital malformations. In adulthood, they mostly result from acquired causes such as iatrogenic trauma after surgeries, infectious or autoimmune diseases, or radiotherapy. However, sometimes it is not possible to determine the exact etiology. Treatment is challenging, with restenosis being the most feared and frequent complication. With this case report, we aimed to highlight the diagnostic and treatment approaches for choanal and nasopharyngeal stenoses in adults. We present a 61-year-old patient with persistent bilateral nasal obstruction and discharge, snoring, and recurrent frontal headaches for years which turned out to be a bilateral choanal and nasopharyngeal stenosis. Previously, the patient had been diagnosed with chronic rhinosinusitis without any other relevant medical history. Additionally, no previous surgical procedures or radiation therapy were found to be associated with the etiology. The patient was treated with surgery. A combined modality of trans-nasal endoscopic excision of choanal and nasopharynx fibrous tissue using cold cutting instruments and posterior septectomy followed by the topical application of Mitomycin-C, without stenting, was an effective option.&lt;/p&gt;

Esophageal Dilation in Children: A State of the Art Review.

Esophageal dilations in children are performed by several pediatric and adult professionals. We aim to summarize improvements in safety and new technology used for the treatment of complex and refractory strictures, including triamcinolone injection, endoscopic electro-incisional therapy, topical mitomycin-C application, stent placement, functional lumen imaging probe assisted dilation, and endoscopic vacuum-assisted closure in the pediatric population.

Effects of topical mitomycin-C on the tracheal epithelia of rabbits following tracheostomy

Background/aim We aimed to investigate the topical application of mitomycin-C (MMC) after the conventional tracheostomy in a rabbit model.Materials and methodsTwenty-four male New Zealand White rabbits were randomly divided among 3 equal groups (n: 8). Tracheostomies were performed on 16 subjects. Group 1 which served as a control for all tracheal measurements. After tracheostomy, we applied sterile saline (group 2) or MMC at 0.8 mg/mL (group 3) around the tracheotomy site for 5 min. At the 3rd week after surgery, all tracheas were subjected to morphometric and histopathological examinations, including tracheal lumen diameter (LD), number of capillary vessels (CV), subepithelial tissue thickness (SETT), fibroblasts, and inflammatory cells (IC).Results There was a statistically significant difference between the two tracheostomy groups themselves and the control group for LD (p = 0.035), CV (p = 0.006), SETT, fibroblasts, and IC (p < 0.001). Histopathological analysis showed the decreased LD, CV, SETT, IC, and fibroblasts compared to MMC with tracheostomy groups. MMC was more effective than saline for LD, CV, SETT, IC, and fibroblasts.Conclusion Wound healing modulation may prevent scar formation. Fibrosis decreased following tracheostomy in the group treated with MMC. Fibroblasts appear to be key cells mediating these effects.

Evaluation of Conjunctival Autografting Augmented with Mitomycin C Application versus Ologen Implantation in the Surgical Treatment of Recurrent Pterygium.

Objectives To evaluate the safety and efficacy of augmenting conjunctival autografting with intraoperative mitomycin C (MMC) application versus Ologen implantation in the management of recurrent pterygium. Materials and Methods This prospective randomised study included 63 eyes of 63 patients, with recurrent nasal pterygium, who presented to the outpatient clinic of Menoufia University Hospital in Shebin El Kom and Manshiet Soltan from January 2016 to December 2019. Patients were randomly enrolled into two groups. Group A included 32 eyes of 32 patients who underwent conjunctival autografting augmented with the topical application of MMC (0.2 mg/mL), and group B included 31 eyes of 31 patients who underwent conjunctival autografting augmented with Ologen implantation. All the patients underwent follow-up examinations for a period of 24 months. During each visit, a complete ophthalmic examination was performed. Pterygium regrowth of 1 mm or more, over the cornea, was considered a recurrence. Results In the MMC group, no recurrence was reported during the 24-month follow-up period. In the Ologen implantation group, recurrence was reported in 2 (8%) eyes. The time interval from surgery to recurrence was 5 months in one case and 8 months in the other. No other serious postoperative complications were reported, and there was no statistically significant difference between the groups in this regard. Conclusion Ologen implantation with conjunctival autografting shows promising results in the surgical management of recurrent pterygium with mild non-vision-threatening postoperative complications comparable to that of MMC application with conjunctival autografting. Registration number: ClinicalTrials.govNCT04419038.

Does bleb needling augmented by mitomycin C or 5‐fluorouracil share similar efficacy with no antimetabolites?

Dear Editor, We have read the article entitled ‘Needling after trabeculectomy - does augmentation by anti-metabolites provide better outcomes and is Mitomycin C better than 5-Fluoruracil? A systematic review with network meta-analyses’ (Halili et al. 2020) with great interest. The authors had concluded no significant difference in the efficacy of using either mitomycin C (MMC), 5-fluorouracil (5-Fu) or no antimetabolites for bleb needling after trabeculectomy, which most doctors may disagree according to the clinical practice. However, there are a few points that need to be clarified before we can state that MMC or 5-Fu application does not outweigh those without antimetabolite usage. One included article retrospectively compared 26 eyes that underwent needling revisions for trabeculectomy failure (Fagerli, et al. 2003). On the one hand, as the individual data presented in this article, four patients had multiple times of needling after the original trabeculectomy. They received the injection of MMC and 5-Fu subsequently. Instead of excluding these cases or analysing them separately, they had abruptly allocated these cases to the MMC group with the presumption that MMC had a more potent effect than 5-Fu. For the current meta-analysis, the inclusion of these inaccurate data reduced the credibility of comparison. On the other hand, the no antimetabolite group in this article had only three cases. In the current meta-analysis, the authors directly compared 13 cases in the MMC group and 10 cases in the 5-Fu group with the 3 cases without antimetabolite application, as Fagerli et al. did in his article. Comparison between small sample sizes data may lead to considerable bias, to a certain degree. As the random effect model was used, it increased the weight of studies with small sample sizes, which magnified its influence on the meta-analysis results. Therefore, ambiguous application of medication and small sample may lower the value of comparison with the inclusion of this article. Another included research focused on topical application of MMC with microsponge before needling revision (Ghoneim & Abd El Hameed 2011). Compared with no antimetabolite group, topical use of MMC brought about significant efficacy in bleb needling. Based on the study design, although the concentration of MMC can be predetermined, the exposure time will be short as irrigation with the balanced salt solution before needling will wash out the antimetabolites. The doses of MMC were therefore inaccurate, as well. In comparison, for the other articles included, antimetabolite augmentation was accomplished by subconjunctival injection of fixed doses within the study. The duration of the antimetabolic effect was prolonged. Though mentioned in the meta-analysis, such difference in drug administration may introduce inaccuracy in assessing MMC’s antifibrotic impact. Selection bias was seen in the included studies. In retrospective studies, patients were selected for antimetabolite injection based on the severity of bleb failure and the judgement from glaucoma specialists (Fagerli et al. 2003; Kim et al. 2019). Under this consideration, those tend to suffer needling failure may be alleviated by antimetabolites and reach similar IOP control and success rate as those only receive needling and have lower chances of failure. The selection bias may hide the potential difference. For the current meta-analysis, all the studies included for the direct comparison of MMC/5-Fu with no antimetabolites were not robust enough to come up with the conclusion. For this reason, we cannot reasonably compare the application of antimetabolites based on the included studies. To sum up, we thought it with low credibility for the comparison of with/without antimetabolites in the current meta-analysis. In agreement with the authors, we call for more extensive randomized studies on this topic.

Efficacy and Safety of the Local Application of Mitomycin C to Recurrent Esophageal Strictures in Children.

Research on long-term use of mitomycin C (MC) for recurrent esophageal stenoses is limited. We assessed the long-term efficacy and safety of local application of MC for recurrent esophageal stenoses in children. This was a retrospective study of 39 patients (17 girls) with a median age of 19.5 months (range: 2.4-196.0) at the time of MC application. The etiologies of stenosis were esophageal atresia (n = 25), caustic ingestion (n = 9), congenital esophageal stenosis (n = 3), and other causes (n = 2). Stenosis was single in 35 (90%) patients and multiple in 4 (10%). Before MC, patients underwent multiple repeated dilations (median: 3 dilations per child [range: 2-26]) over a median period of 7 months (range: 2.6-49.3). Treatment success was defined a priori as a reduction in the number of dilations over the same period from before to after the application of MC. For 26 (67%) patients, the application of MC was considered a success: 102 versus 17 dilatations (P < 0.0001). Sixteen (41%) patients never required additional dilation during the follow-up after MC application (median: 3.1 years [range: 0.6-8.5]). No complication related to MC was observed. Biopsies at the site of MC application were performed at maximal follow-up in 16 patients and revealed no dysplasia. Three factors were associated with success of MC: single stenosis, short stenosis, and esophageal atresia type III. This study is the largest series reported showing that topical application of MC is an efficient and safe treatment for recurrent esophageal stenosis in children.

Corneal Melt with Perforation Following Topical Mitomycin-C Application in Pterygium Excision

Corneal Melt with Perforation Following Topical Mitomycin-C Application in Pterygium Excision

Comparing Preoperative Injection of Mitomycin-C vs. Intraoperative Injection of Mitomycin-C vs. Topical Application of Mitomycin-C (Conventional Use) in Trabeculectomy

Comparing Preoperative Injection of Mitomycin-C vs. Intraoperative Injection of Mitomycin-C vs. Topical Application of Mitomycin-C (Conventional Use) in Trabeculectomy

Effect of mitomycin-C applied through different approaches following tracheal surgery on development of granulation tissue and level of nephrotoxicity in rats.

This study aims to evaluate the effect of mitomycin-C applied through different drug administration approaches on the development of granulation tissue in the field of surgery and renal functions in rats which underwent tracheal surgery. Fifty male adult Sprague Dawley rats (weighing mean 200 g to 300 g) were divided into five groups. An incision was performed between the fifth and sixth cartilage ring of the trachea in all groups under anesthesia and the incision was primarily repaired with a 6/0 monofilament absorbable suture. A single dose of mitomycin-C 0.5 mg was applied in the experimental animals appropriate with their assigned groups as topical, intraperitoneal injection, injection to the wound edges, and through inhalation. No mitomycin-C was administered in one group which was accepted as the control group. Rats were sacrificed four weeks after surgery and their tracheas were excised subsequently. Tracheal tissue samples were histopathologically evaluated in terms of epithelization, fibrosis, amount of fibroblasts, angiogenesis, and inflammatory response. Diameter and wall thickness of the tracheas were measured. Blood urea and creatinine levels were evaluated for nephrotoxicity, and the rats were immunohistochemically examined for glomerular pathology. Epithelization was statistically significantly decelerated (p<0.01), diameter of the trachea was statistically significantly larger (p<0.05), and wall thickness of the trachea was significantly thicker in the group with topical mitomycin-C application compared to the control group (p<0.01). Topically applied mitomycin-C following tracheal surgery slows down epithelization and, thus, decreases the development of granulation tissue and maintains a wider diameter of the trachea.

Karakteristik pasien ocular surface squamous neoplasia di Pusat Mata Nasional RS Mata Cicendo periode Januari 2012- Juni 2014

&#x0D; &#x0D; &#x0D; Background: Ocular surface squamous neoplasia (OSSN) is a broad term encompassing conjunctival intraepithelial neoplastic lesions (CIN) and invasive squamous cell carcinoma (SCC) of conjunctiva and cornea. The purpose of this study is to describe the demographic, clinical, therapy and histopathology characteristics of OSSNs patients in Cicendo Eye Center within period of January 2012 – June 2014. Methods: Patient medical records were reviewed. Fourty patients of biopsy-proven OSSN at Cicendo Eye Centre from January 2012 until June 2014 were reviewed. &#x0D; Results: Data was collected from 40 patients (41 eyes), OSSN was more frequent in men (62.5%) and had unilateral presentation (97.5%). The mean patient age was 45.9±14.7 years. The most common complaint was lump on the ocular surface (50%). The size of lesion was mostly less than 2 mm (62.5%). All of the patients were managed with surgery using wide excision and histopathology examination, of whom 46.4% cases were managed with wide excision only, 41.4% cases were managed with wide excision and application of topical mitomycin C (MMC), 12.2% cases were managed with wide excision, application of topical MMC, and cryotherapy. Histopathology examination revealed that 41.5% cases were CIN, 19.5% cases were carcinoma in situ, and 39% cases were invasive SCC. &#x0D; Conclusions: Patients with OSSN who came to Cicendo Eye Center were mostly male and had unilateral presentation. The most common clinical sign and symptom were ocular surface mass with size of the lesion less than 2 mm. Management of patient with OSSN is mostly excisional surgery only. Majority of histopathology examination showed CIN. &#x0D; &#x0D; &#x0D;

Safety and complications after three different surface ablation techniques with mitomycin C: a retrospective analysis of 2757 eyes.

To evaluate the safety and spectrum of complications of three excimer laser surface ablation techniques (SATs) with an intraoperative application of mitomycin C (MMC) 0.02%. A retrospective, non-comparative large case series. SATs were performed on 2757 eyes with a preoperative spherical equivalent (SE) of - 4.41 ± 2.44 and a Wavelight Allegretto 200 platform. Ablation zone diameters between 6.0 and 7.0mm were used according to mesopic pupil size. All patients were treated with an intraoperative application of MMC for 30 to 90s depending on refractive error. The mean follow-up time was > 3months (107 ± 24days). Complication range and incidence were analyzed retrospectively and safety index was calculated. Two thousand seven hundred and fifty-seven eyes met the inclusion criteria for surface ablation. Two thousand five hundred and seventy-three eyes were assigned to alcohol-assisted photorefractive keratectomy (APRK), 135 eyes to transepithelial photorefractive keratectomy (TPRK), and 49 eyes to off-flap epithelial laser in situ keratomileusis (EpiLASIK/EpiK). Overall, the safety index was 1.06 ± 0.28. Haze was graded according to the Fantes scale. Haze incidence rates were highest in the TPRK group (14.81%) and comparably low in APRK (2.95%) and EpiK (4.08%) groups. Intraoperative topical application of MMC (0.02%) results in good safety and no severe side effects. However, highest incidence of haze was observed after TPRK. The more frequent peripheral localization of haze might be attributed to large ablation zones and the wavefront optimized ablation profile especially in the PTK modus of the laser platform.

A comparative, randomized, contralateral study between the use of Mitomycin-C and accelerated cross-linking as adjuvant therapy after trans-epithelial all surface laser ablation for moderate to high myopia (ASLA-MMC vs. ASLA-XTRA): a pilot study

ABSTRACTObjectives: The purpose of our study is to compare accelerated corneal cross-linking (CXL) against topical application of Mitomycin-C (MMC), in patients undergoing all-surface laser ablation (ASLA) for moderate-to-high myopia and/or myopic astigmatism contralaterally and evaluate the efficacy of this technique in the prevention of postoperative corneal haze formation as well as the efficacy of refractive results.Methods: This prospective study consisted of 34 eyes of 17 myopic (range: −4.00 to −10.5 D, SD: 2.11) patients (8 males, 9 females). Mean age was 26.88 years (SD: 6.04, range: 19–36 years). One eye was randomly selected to ASLA with MMC while the contralateral eye underwent ASLA with accelerated CXL.Results: There was no statistically significant difference in the UDVA between the two groups at all postoperative time intervals (1,3,6, and 12 months). The keratometric values of the eyes and the haze score showed no statistically difference between the two groups at any time point.Conclusion: ASLA combined with accelerated CXL(ASLA-XTRA) appears to be a safe alternative to the use of MMC as an adjuvant treatment in moderate and high myopia. The potential additional benefits of this modality are the stabilizing effect of the refractive result and its sterilization effect on the treated cornea.

Novel grid and sectoral analyses in monitoring corneal scars.

We aim to design two sampling methods, the grid and sectoral methods, to provide more precise detection of focal corneal scar changes with time following pterygium excision with the Pentacam imaging system. This is a retrospective study of our previous prospective observational case series. Thirty patients underwent primary pterygium excision with adjuvant topical mitomycin-C application were followed up and imaged with Pentacam system at postoperative weeks 1, 4, 12 and month 18. Grid and sectoral methods were used to sample density changes (in grayscale units, GSU) over the scarred areas as well as the clear pole of the same cornea. Using the grid method, the average corneal densities were 39.4, 37.1, 36.7 and 34.7GSU at postoperative 1, 4, 12weeks and 18months, respectively. On the other hand, using the sectoral method, the average corneal densities were 35.3, 33.3, 32.5 and 31.9GSU at postoperative 1, 4, 12weeks and 18months, respectively. Paired t tests achieved statistical significance when comparing all follow-up time points to first postoperative visit. A statistically significant effect of time on the average density was shown on ANOVA (p < 0.001) using both analyses over the scarred areas, but not over the clear pole of the same cornea (p > 0.05). Our novel approach to monitor corneal density changes using the grid or sectoral sampling methods seemingly enhances the power in monitoring density changes in corneal scars when compared to conventional total-diameter average densitometry.

Prospective study of the effect of topical application of Mitomycin C in refractory pediatric caustic esophageal strictures.

Esophageal strictures resulting from caustic ingestion in children are usually difficult to be managed, and surgical replacement is usually required for cases refractory to frequent dilatation sessions. Topical Mitomycin C (MMC) has been recently used in the management of resistant strictures. We evaluated the efficacy of MMC application in treatment of long refractory caustic esophageal strictures. This prospective study included 120 patients of both sexes with refractory caustic long esophageal strictures (> 3cm in length). All patients were randomly divided into two equal groups using the research randomizer program (1:1 randomization), group I underwent endoscopic dilatation therapy only and group II underwent dilatation with topical application of MMC. Follow-up was done regularly by assessing the dysphagia score and patients were evaluated after 6 months of management. The procedure was repeated four times with 2-week intervals. Complete relieve of symptoms (dysphagia score = 0) was assessed after the follow-up period. The complete cure was detected in 81.6% of patients in the MMC group compared to only 40% in the first group, p-value < 0.0001. During the follow-up, the average sessions of dilatation needed in group II were 3.25 ± 2.78 compared to 6.25 ± 1.74 sessions in group I (p < 0.001). The mean cost of sessions in patients who showed symptomatic and endoscopic improvement was significantly lower in group II (272.2 ± 51 US$) when compared to group I (404 ± SD 55.7 US$). Cure rate was double in the MMC group. MMC application significantly improved symptoms and reduced both the number and frequency of dilatations to alleviate dysphagia in patients with refractory caustic esophageal strictures and hence reduced the cost of treatment.

Study of Endonasal Endoscopic Dacryo-cystorhinostomy with Special Reference to Mitomycin-C.

The aim of this study was to evaluate long-term results in patients with nasolacrimal duct obstruction treated with intranasal endoscopic dacryo-cystorhinostomy (DCR) with intraoperative topical application of mitomycin-C. The procedure was carried out in 34 subjects (41eyes). Patients with post-saccal stenosis were divided into two groups, 21 patients were treated with intranasal endoscopic dacryo-cystorhinostomy with intraoperative application of Mitomycin-C (MMC) and the other 20 cases underwent procedure only without Mitomycin-C. Effectiveness of drug at rhinostomy site was assessed in relation to granulation formation, adhesions and ostium size. Outcomes were assessed on the basis of relief of subjective symptoms, patency of rhinostomy site confirmed via syringing and final ostium size at end of 6months, 1 and 2year. Success rate was 100% at 3 and 6months follow-up in both the groups. At the end of 1year, one failure was noted in control group which had to undergo revision endoscopic DCR with overall success rate decreasing to 97%. This was maintained at the end of second year. Results revealed that adjunctive use of Mitomycin-C was effective at 3months when granulation tissue formation was significantly lesser in MMC group compared to no MMC group. Topical application of Mitomycin-C has been found to be beneficial in preventing adhesions and also resulted in larger neo-ostium. We concluded that results with intraoperative topical application of Mitomycin-C in endoscopic dacryo-cystorhinostomy are encouraging. It can favourably affect wound healing and result in larger rhinostomy size/ostium. Mitomycin-C is safe and effective adjunct in endoscopic dacryo-cystorhinostomy procedure. Level of evidence Individual prospective cohort study, level 1b.

Systemic Absorption of Mitomycin-C When Used in Pterygium Surgery.

To determine whether scleral topical application of mitomycin-C (MMC) results in measurable plasma levels of systemic absorption. The study comprised 27 patients who were treated with MMC 0.2 mg/mL (0.02%) for 60 seconds during pterygium surgery. Blood samples were taken 30 minutes after surgery and evaluated by the human plasma liquid chromatography tandem-mass spectrometry method to determine the presence of MMC. The amount of MMC in 27 samples tested was determined as below 0.25 ppb (ng/mL). In this study of 27 patients treated with topical application of MMC for pterygium surgery, there was no measurable evidence of systemic drug absorption. Although systemic absorption has been found with the use of larger quantities of MMC, there is an extremely low likelihood of systemic absorption or toxicity of MMC after pterygium surgery.

Mitomycin C in the endoscopic treatment of tracheal stenosis: a prospective cohort study.

ABSTRACTObjective:To evaluate the efficacy of mitomycin C (MMC) in the endoscopic treatment of tracheal stenosis. Methods:Patients with laryngotracheal, tracheal, or tracheobronchial stenosis were treated with dilation and topical MMC. The inclusion criteria were as follows: being ineligible for surgery (for medical reasons) at the time of evaluation; membranous stenosis responding well to dilation; and postoperative stenosis at the anastomosis site. Etiology of stenosis and indication for treatment with MMC, as well as site, length, and percentage of stenosis, together with presence of tracheostomy and duration of follow-up, were analyzed. The outcomes evaluated were symptom-free interval ≥ 12 months, number of dilations with topical application of MMC, and complications. Results:Twenty-two patients (15 men and 7 women) were treated between 2003 and 2010. Stenosis was due to endotracheal intubation in 15 patients and surgery in 8. Pure tracheal stenosis was encountered in 13 patients, subglottic stenosis was encountered in 4, tracheobronchial stenosis was encountered in 3, and complex stenosis was encountered in 2. The length of stenosis ranged from 0.5 cm to 2.5 cm, and the percentage of stenosis ranged from 40% to 100%. Nine patients had undergone tracheostomy and had a Montgomery T-tube in situ. Treatment was successful in 14 patients, who remained free of symptoms for at least 12 months. The number of topical applications of MMC ranged from 1 to 5, and complications included fungal infection, keloid scarring, granuloma, and mediastinal emphysema. Conclusions:MMC appears to be effective in the endoscopic treatment of tracheal stenosis.

Topical Mitomycin C Application Is Effective Even in Esophageal Strictures Resistant to Dilatation Therapy in Children.

Several treatment techniques may be used in the treatment of esophageal strictures. The purpose of this study was to present the effects of topical mitomycin C (TMC) as an useful adjunct to dilatation therapy in esophageal strictures. A retrospective analysis of patients who underwent TMC between February 2015 and July 2016 was performed. Dysphagia score, periodic dilatation index, and number of dilatations were compared before and after intervention to investigate the efficacy of TMC. TMC was performed on 20 patients with a median age of 3.5 years (2 to 17 y). The diagnosis was corrosive esophageal strictures in 14 patients, anastomotic strictures in 5 patients, and congenital esophageal stricture in 1 patient. The length of the stricture was long in 10 patients (50%). The median dysphagia score decreased from 2 (1 to 3) to 0 (0 to 2) after application (P<0.001). The median number of dilatation sessions decreased from 5 (1 to 41) to 1 (0 to 11) after intervention (P<0.001). The median periodic dilatation index decreased from 1 (0.66 to 1.34) to 0 (0 to 1.33) after TMC (P<0.001). Regular esophageal dilatation was not necessary in 16 patients after application (80%). The length of the stricture did not affect the efficacy of TMC. The success of treatment was lower in patients with a long treatment period before TMC (>3 y) (50%). No complications were seen in a median follow-up period of 16 months (7 to 22 mo). TMC application has a significant positive effect as an adjunct to dilatation therapy in most of the patients with different types of esophageal strictures. It should be performed as a safe and efficient treatment option even in patients who were resistant to dilatation therapy.

Topical Mitomycin Application Can Improve the Outcome of Recurrrent Benign Esophageal Strictures

Introduction: Recurrent benign esophageal strictures represent a subset of complex esophageal strictures. Application of Mitomycin C (MMC) was shown recently in small case series to improve the outcome of complex benign strictures; however these studies were mainly limited to pediatric populations. The aim of this study is to investigate and update our outcome of topical MMC application for recurrent benign esophageal strictures which failed prior standard dilation.Figure 1Figure 2Methods: Prospectively collected data was abstracted by retrospective chart review of all patients who underwent topical MMC application for recurrent benign esophageal strictures between 2008 and 2015. All patients underwent balloon dilation followed by topical MMC application over 2-3 minutes (0.4mg/ml). The primary endpoint was to demonstrate an improvement in the periodic dilation index (PDI) and dysphagia score. The secondary endpoint was to determine complication rates. Results: 12 patients (mean age 70 years, SD 11.6; 42% male) with 5 anastomotic (41%), 2 radiationinduced (17%), 2 combined anastomotic and radiation-induced (17%), 2 caustic (17%), and 1 peptic (8%) stricture were included. Strictures had a mean length of 13mm (SD 6.7) and mean diameter of 8.1mm (SD 2.6). Prior to topical MMC application, all patients required an average of 8.5 dilations (SD 5) over 6.7 months (SD 3.7). Additionally, patients had a median dysphagia score of 3, SD 1 (Table 1). At the index dilation with MMC application, strictures were dilated to a mean diameter of 14.1mm (SD 2.2). One patient had concomitant stent placement and 6 patients underwent additional needle knife incision prior to balloon dilation. During follow up (10 months, SD 8.7) 10 patients developed recurrent stricture verified by EGD, however PDI improved from 1.5 (SD 0.9) to PDI 0.3 (SD 0.3) following MMC application (p=0.022). In addition to dilation patients with recurrent strictures underwent repeat MMC application or incisional therapy or stent placement (Table 2). The dysphagia score decreased from a median of 3 to 2 (p=0.046). One patient developed vocal cord paralysis following MMC application; however it was considered unrelated to treatment. No other complications were recorded. Conclusion: MMC application in conjunction with dilation decreases the frequency of esophageal dilations in patients with highly recurrent benign esophageal strictures, although strictures continue to form. Not all patients benefit from MMC treatment, as 2 patients required esophagectomy.