Recurrent Esophageal Strictures Research Articles

A case of a patient with respiratory tract papillomatosis and recurrent esophageal strictures

<br><b>Introduction:</b> Recurrent respiratory papillomatosis is a rare disease with chronic and unpredictable course. The disease is an outcome of the HPV infection and it is characterized by the exophytic papillomas in the respiratory tract. Patients with RRP present a number of symptoms, from which the most dominant ones are hoarseness and dyspnoea. Treatment is mostly based on surgical procedures as well as adjuvant therapies.</br> <br><b>Case report:</b> We present a case report of a 26-year old female patient with recurrent respiratory papillomatosis and comorbid recurrent esophageal strictures of unknown etiology.</br> <br><b>Discussion:</b> RRP is a disease with both periodic intensifications of the symptoms and remissions. The course of the illness can be mild or aggressive. Patients with papillomatosis undergo numerous surgical procedures in the respiratory tract, which predisposes them to scars and adhesions in this area together with voice impairments and dysphagia.</br> <br><b>Conclusions:</b> RRP is a relatively rate disease associated with many complications of survival treatment. Currently, due to the lack of effective causal treatment methods, patients are exposed to side effects of surgical procedures, hence it is important to continue activities aimed at obtaining standardized therapies that will improve the quality of life of patients with RRP.</br>

S2701 A Rare Case of Esophagitis Dessicans Superficialis Presenting as Recurrent Esophageal Strictures

S2701 A Rare Case of Esophagitis Dessicans Superficialis Presenting as Recurrent Esophageal Strictures

Validity and Reliability of the European Organization Research and Treatment of Cancer Quality of Life Questionnaire-Oesophagogastric 25 in Indian Patients With Corrosive-Induced Benign Refractory Esophageal Strictures.

Background The European organization Research and Treatment of Cancer Quality of Life Questionnaire-Oesophagogastric 25 (EORTC QLQ-OG 25) is designed for patients with esophagogastric cancer. Its performance has never been tested with benign disorders. A health-related quality-of-life questionnaire does not exist for patients with benign corrosive-induced esophageal strictures. Hence, we evaluated the EORTC QLQ-OG 25 in Indian patients with corrosive strictures. Methods The English or Hindi version of QLQ-OG 25 was administered to 31 adult patients undergoing outpatient esophageal dilation at GB Pant hospital, New Delhi. These patients had refractory or recurrent esophageal strictures due to corrosive ingestion and had not undergone reconstructive surgery. Score distribution was analyzed, and item performance was determined based on floor and ceiling effects. Convergent validity, discriminant validity, and internal consistency were checked. Results The average time to finish the questionnaire was 6.70 minutes. Most scales fulfilled convergent validity (corrected item-total correlation >0.4), barring the Odynophagia scale and one item of the Dysphagia scale. Most scales exhibited divergent validity except for odynophagia and one item of dysphagia. Cronbach's alpha was >0.70 for all scales except odynophagia. Responses to questions evaluating taste, cough, swallowing saliva, and talking were highly skewed and had prominent floor effects. Overall, the questionnaire demonstrated good internal consistency, convergent validity, and divergent validity in benign corrosive-induced refractory esophageal strictures patients. Conclusion The EORTC QLQ-OG 25 can be satisfactorily used in patients with benign esophageal strictures to assess health-related quality of life.

Comparison of the efficacy and complications of endoscopic incisional therapy and balloon dilatation for benign esophageal strictures

Background: Benign esophageal strictures are treated endoscopically, often with balloon dilatation (BD) or bougie dilators. However, recurrent esophageal strictures have been reported after BD, and severe complications sometimes occur. The aim of this study was to compare the efficacy and complications of endoscopic incisional therapy (EIT) and BD for benign esophageal strictures.Methods: We retrospectively reviewed patients who underwent BD or EIT as primary treatment for benign esophageal strictures between July 2014 and June 2021. Technical success was defined as restoration of the lumen diameter with <30% residual stenosis. Clinical success was defined as no recurrence of dysphagia within 1 month after BD or EIT and an increase of 1 grade or more on the Functional Oral Intake Scale.Results: Thirty patients with benign esophageal stricture were enrolled. There were 16 patients in the BD group and 14 patients in the EIT group. No significant differences in technical and clinical success rates were found between the two groups. Furthermore, no significant differences in the re-stricture rate were observed between the groups. There was one complication in the EIT group and three complications in the BD group. Three patients who underwent BD had re-stricture and underwent EIT thereafter, and we regrouped patients who underwent EIT at least once. The clinical success rate was significantly higher in patients regrouped to the EIT group than in patients who underwent BD only.Conclusions: EIT is not inferior to BD as the primary treatment for benign esophageal strictures, especially for recurrent cases.

S2852 Dislodged Esophageal Stent Extracted via PEG Tube Site: An Uncommon Solution for a Real Life Problem

Introduction: Esophageal stents have been used for management of refractory benign strictures and has risk of stent migration even with endoscopic suturing or clipping techniques. With esophageal stricture present, the retrieval of the migrated stent becomes a dilemma. We present one such case that required retrieval of the migrated stent through a pre-existing percutaneous endoscopic gastrostomy (PEG) tube site. Case Description/Methods: A 62-year-old man with history of supraglottic small cell carcinoma treated with chemo-radiation therapy developed a severe benign esophageal stricture. He had multiple esophageal dilations and steroid injections which failed and eventually treated by esophageal stent placement with stent fixation via endoscopic suturing. He presented with food impaction and esophagogastroduodenoscopy (EGD) found a severe distal esophageal stricture which could only be traversed with a pediatric gastroscope. The previously placed 20mmx80mm fully covered self-expanding metal stent (FCSEMS) had migrated into the stomach (Figure 1a). Exhaustive attempts at endoscopic retrieval past the esophageal stricture was unsuccessful. He had a pre-existing 20Fr PEG tube and the PEG tract was gradually dilated to 15mm. An adult gastroscope was passed through the PEG site and a raptor forceps was used to grab and extract the forceps successfully (Figure 1b-c). A new 24Fr PEG tube was placed. Mild oozing was seen in the tract, otherwise patient tolerated the procedure well. He was referred to discuss surgical options for further treatment of his esophageal stricture. (Figure) Discussion: Esophageal stents are being increasingly utilized in the management of not only malignant strictures, but also benign esophageal disease such as recurrent esophageal strictures, anastomotic leaks, perforations and fistulae. Stent migration may occur frequently in benign disease with risk factors being use of FCSEMS, distal location and previous migration. An unretrieved stent may cause small bowel obstruction. Anchoring stents with endoscopic suturing, and clips may reduce the risk of migration. If unable to be removed endoscopically then a surgical approach will be needed. Luckily, the presence of a mature gastrostomy tract provided an alternate extraction route for our patient. Risks associated with this modality include bleeding, gastrostomy site disruption, gastric perforation and peritonitis. Increased physician awareness of endoscopic options in such a case may obviate the need for surgical intervention.Figure 1.: Endoscopic image of dislodged esophageal stent in stomach (a). Endoscopic image of adult gastroscope passed through PEG site dilated with CRE balloon (b). Image of dislodged esophageal stent retrieved via dilated PEG site (c).

Benign Esophageal Stricture

Benign esophageal strictures, characterized by fibrotic narrowing of the esophageal lumen, are frequently encountered in clinical practice. Benign esophageal strictures are associated with a multifactorial etiology and may occur across various age and population groups. Common causes of benign esophageal strictures include gastroesophageal reflux disease (peptic stricture), esophageal injury secondary to surgery (anastomotic strictures), radiotherapy, caustic agent ingestion, or endoscopic resection. Benign esophageal strictures are categorized into simple and complex types based on their size, area involved, surface features, extent of luminal narrowing, and margins. Esophageal strictures often present clinically with dysphagia and may lead to severe complications. Regardless of the underlying cause, therapy is aimed at relief of dysphagia and prevention of stricture recurrence. Benign esophageal strictures are commonly treated using endoscopic balloon or bougie dilation, followed by disease-specific approaches to treat underlying inflammation. However, based on the underlying cause, the risk of recurrence of benign esophageal strictures is 10~30%. Therapeutic options for refractory or recurrent esophageal strictures include endoscopic incisional therapy, esophageal stent placement, or intralesional injection of steroids or mitomycin C. The pathophysiology of esophageal strictures is complicated, and thorough understanding and patient cooperation are important for optimal management. Physicians should familiarize themselves with the various dilation strategies available and their application for management of specific types of stenotic lesions. In this article, we review the evaluation and management of patients with esophageal strictures.

Utility of radial incision and cutting with steroid injection for refractory stricture after endoscopic submucosal dissection for large superficial esophageal squamous cell carcinoma.

Endoscopic submucosal dissection (ESD) for superficial esophagus squamous cell carcinoma (SESCC) may cause esophageal stricture and related dysphagia symptoms, especially when the lesion is widespread. Endoscopic balloon dilation (EBD) is the prior choice to treat post-ESD stricture. However, certain patients show poor response to EBD treatment and frequent dilations are required. We perform radial incision and cutting combined with intralesional steroid injection to manage refractory stricture. The study aims to evaluate the safety and efficacy of this new combined treatment. From October 2017 to February 2019, 25 patients who accepted repeated EBD because of refractory stricture after extensive ESD for large SESCC were enrolled. Radial incision and cutting followed by local steroid injection was performed on all the patients, and therapeutic EBD was conducted to treat recurring stricture after combined treatment. The incidence of recurrent stricture, clinical outcome of combined treatment, and following therapeutic EBD, procedure-related adverse events were assessed and analyzed. During the follow-ups, the incidence of recurrent esophageal strictures was 92%. Combined treatment reduced the severity of stenosis and lowered the corresponding dysphagia scores significantly, compared with previous EBD. Mean symptom-relief duration of EBD was prolonged significantly from 29.9 to 76.0days. Perforation was observed in one patient during operation and successfully sealed with metal clips. Combination of radial incision and cutting with steroid injection is a safe and feasible treatment for esophageal refractory stricture after extensive ESD, appearing to improve the therapeutic EBD outcome and maintain a longer symptom-relief duration.

Comparison of the Efficacy and Safety of Endoscopic Incisional Therapy and Balloon Dilatation for Esophageal Anastomotic Stricture

BackgroundBenign esophageal anastomotic strictures have typically been treated using endoscopic methods, often with balloon dilatation (BD). However, recurrent esophageal strictures after BD have been reported. We evaluated the efficacy and safety of endoscopic incisional therapy (EIT) and BD for treating an anastomotic stricture after a total gastrectomy. MethodsSubjects who underwent EIT or BD as a first treatment for esophagojejunostomy anastomotic stricture after a total gastrectomy between January 2010 and December 2018 were eligible. The medical records of these cases were retrospectively reviewed. Stricture was defined as an inability to pass a normal diameter endoscope (10.2 mm). The stricture area was incised under direct vision with the nano-insulated-tip knife in a radial fashion parallel to the longitudinal axis of the esophagus. ResultsTwenty-one patients in our database presented with benign anastomotic stricture after a total gastrectomy for advanced gastric cancer. The BD group included 12 patients. The remaining nine patients underwent EIT, and three of these cases received an immediate additional BD. The re-stricture rate was significantly different between the BD and EIT groups (41.7% vs. 0%, respectively; P = 0.045). There were no significant differences in procedure time, interval from surgery to first stricture, hospitalization period, or complication rates between the groups. One patient developed a microperforation during BD and was treated without surgical intervention. ConclusionsEIT is a safe and effective primary treatment modality compared with BD for esophagojejunostomy anastomotic stricture after a total gastrectomy as it shows a significantly lower re-stricture rate.

S1895 A Case of Esophageal Epidermoid Metaplasia in a Patient With Recurrent Esophageal Strictures

S1895 A Case of Esophageal Epidermoid Metaplasia in a Patient With Recurrent Esophageal Strictures

Flexible endoscopic strategies for the difficult esophageal stricture.

Benign strictures of the esophagus, caused by various causes, are frequently encountered in clinical practice. Although endoscopic dilation is still the standard and first-line therapy, complex and difficult esophageal strictures are still encountered and remain a challenge to endoscopists. The main scope of this review article is to offer a closer look at the different endoscopic modalities and approaches to complex and difficult esophageal strictures. In the past few years, endoscopic dilatation, stents including self-expandable and biodegradable types, incisional therapy, and pharmacological treatments have been utilized in the prevention and management of refractory and recurrent esophageal strictures. Meanwhile, more recent techniques such as the BougieCap, percutaneous transgastric endoscopic myotomy, through-the-scope stents, radial incision and cutting, etc. have been developed as alternative methods. A number of studies utilizing these newer methods have shown promising results in the treatment of complex and difficult esophageal strictures. Endoscopic treatment of refractory, complex and difficult esophageal strictures still remains to be a challenge for many endoscopists. While balloon or bougie dilatation still remains to be the first-line approach, other techniques have emerged as treatment alternatives and may become adjunct therapy to endoscopic dilatation.

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.

A Rare Case of Chilaiditiʼs Sign Associated with Cervical Neuropathy

Chilaiditi's sign, the colonic interposition between the liver and diaphragm, is an uncommon radiographic finding.1 While it has been previously observed in the setting of cirrhosis, chronic obstructive pulmonary disease, obesity, near-term pregnancy, mental disorder, and primary lung cancers, its etiology is unknown.2 We describe a case of a man with cervical neuropathy and esophageal strictures as a consequence of radiation therapy and a total laryngectomy for head and neck carcinomas, who was found to have Chilaiditi's sign following an endoscopic esophageal dilation. A 70-year-old man was referred to our clinic for endoscopic dilation of known esophageal strictures in the setting of progressive dysarthria, dysphagia, and weight loss. He was initially treated with radiation therapy for nasopharyngeal carcinoma at age 47, and at age 55, he underwent a total laryngectomy and additional radiation for supraglottic laryngeal carcinoma. During the next fifteen years, he developed progressive dysarthria and weakness of the neck, shoulder, and rotator-cuff muscles secondary to nerve impingement from extensive fibrosis, lymphedema, and neck scarring. He developed dysphagia due to recurrent esophageal strictures, responsive to periodic endoscopic dilations. A repeat, uneventful endoscopic esophageal dilation was performed, after which he returned to clinic three days later with complaints of subjective fevers and heartburn. He denied abdominal pain, nausea, vomiting, or melena. His examination was notable for vitals within normal range and decreased breath sounds in the right lung base. A CT with oral contrast revealed an increase in the elevation of the right hemi-diaphragm with interposition of the colon between the liver and right hemi-diaphragm, consistent with Chilaiditi's sign (Figures 1-3). He was managed conservatively given lack of dyspnea and resolution of his fevers and heartburn. The etiology of Chilaiditi's sign is unknown and rarely discussed in the literature. Our case highlights a potential association between Chilaiditi's sign and cervical nerve damage as a result of post-laryngectomy and radiation-induced fibrosis. Fibers from the C3, C4, and C5 nerve roots innervate the muscles of the upper extremity and neck and also compose the phrenic nerve. Our patient's cervical neuropathy and its potential effects on diaphragmatic function may serve as a causative link between the two findings.1498_A Figure 1. Coronal CT slice of the colonic interposition between liver and diaphragm1498_B Figure 2. Second coronal CT slice of Chilaiditi's sign1498_C Figure 3. Axial CT slice demonstrating Chilaiditi's sign

Topical Mitomycin C Application in Pediatric Patients with Recurrent Esophageal Strictures-Report on Unfavorable Results.

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.

IgG4-related disease involving the esophagus: a clinicopathological study.

Immunoglobulin G4 (IgG4)-related disease is a recently coined systemic disease characterized by specific histopathologic findings of an intense lymphoplasmacytic infiltrate, storiform fibrosis, and obliterative phlebitis in the presence of predominant IgG4-positive plasma cells. Although IgG4-related disease has been described in many organs, involvement of the esophagus is very rare. In this study, we describe the clinicopathologic characteristics of eight patients with IgG4-related esophagitis. We evaluated chronic esophagitis specimens with lymphoplasmacytic infiltrate obtained over the past 6 years (from January 2011 to February 2017) using a chart review, pathologic examination, and IgG4 immunohistochemical staining. The diagnoses of the specimens were either confirmed as IgG4-related esophagitis (IgG4-RE) or chronic esophagitis, not otherwise specified (CENOS), and the clinicopathologic data from each group were compared. Eight patients were diagnosed with IgG4-RE and 10 controls were identified and diagnosed with CENOS. In the IgG4-RE group, esophageal strictures were identified in three patients, two patients had postmyotomy treated achalasia, one patient had erosive esophagitis and another presented with an esophageal nodule. Only one patient had an unremarkable mucosa on endoscopy. In the CENOS group, four patients had esophageal strictures, six had erosive esophagitis, one patient had mild esophagitis. The IgG4-RE group had significantly higher numbers of IgG4-positive plasma cells (66.9±21.9 vs. 4.7±2.4 per high power field; P<0.001) and a greater IgG4: IgG ratio 0.76±0.13 vs. 0.06±0.05; P<0.001) when compared to CENOS patients. Two of the patients with recurrent esophageal strictures in the IgG4-RE group showed initial response to steroid therapy and are currently on immunosuppressive therapy which has significantly reduced the need for multiple esophageal dilatations. The presentation of IgG4-related esophageal disease can vary and the key to diagnosis is dependent on histopathology. These observations highlight the need for IgG4 immunohistochemical staining of esophageal biopsies especially in patients with mucosal ulceration, chronic inflammation, and plasmacytosis on biopsy. This will prevent unwarranted esophagectomies and failed medical treatment due to lack of recognition of this entity.

Recurrent Dysphagia: A Case with High Morbidity After Esophageal Stenting

Introduction: Esophageal stents are currently being used for management of a variety of conditions including malignant esophageal obstruction, extrinsic esophageal compression, refractory or recurrent esophageal strictures, tracheoesophageal fistula and esophageal perforation or leak. It is associated with multiple complications; one of them being recurrent dysphagia and need for multiple dilatations and laser therapy. Case: A 67 year old gentleman with past medical history significant for essential hypertension, chronic obstructive pulmonary disease and stage IIIC, grade 1 squamous cell esophageal carcinoma status post chemotherapy and radiation therapy two and half years ago and currently in remission presented with increased salivation and drooling; and also regurgitation after taking anything per oral. As a complication of radiation therapy, he had developed tracheoesophageal fistula for which he had undergone esophageal stent placement. He had multiple episodes of stent occlusion; from food, granulation tissue, prolapsing esophageal mucosa and epithelial hyperplasia requiring multiple dilatations and laser therapy. He also had been losing weight. To help him with nutrition, a percutaneous endoscopic gastrostomy tube had been placed 18 months from the time of stent placement. In the last two and half years since stent placement, he has had the need for stent dilatation and laser therapy 8 times and continues to have the need for it. He is to go for another esophagogastroduodenoscopy, dilatation and laser therapy under anesthesia during this admission. Conclusion: Esophageal stent placement though rewarding is associated with multiple complications. Delayed complications are the ones that occur 2-4 weeks after the stent placement and are seen to occur in 53-65% of patients; reintervention rate being as high as 50%. Recurrent dysphagia is seen in about 22% of the cases and can occur due to tumor growth, epithelial hyperplasia or granulation tissue formation. The dysphagia usually stabilizes after 2 to 3 balloon dilatations and laser therapy. Our patient continues to have recurrent dysphagia, has a PEG tube in place and has required multiple balloon dilatations and laser therapy. He has been getting admitted every 7-8 weeks for the procedure; a significant morbidity.Figure 1

Tu1605 Outcomes of Endoscopic Injection of Mitomycin C for Refractory Recurrent Benign Esophageal Strictures

Tu1605 Outcomes of Endoscopic Injection of Mitomycin C for Refractory Recurrent Benign Esophageal Strictures

Topical Mitomycin‐C Application in Recurrent Esophageal Strictures After Surgical Repair of Esophageal Atresia

The aim of the present study was to evaluate the efficacy and short-term safety of topical mitomycin-C, an antifibrotic agent, in preventing the recurrence of anastomotic strictures after surgical repair of esophageal atresia (EA). We retrospectively reviewed the medical records of patients with recurrent anastomotic strictures after EA surgery who underwent at least 3 esophageal dilations. We compared the outcome (ie, resolution of the stricture) of the group that received topical mitomycin-C treatment with endoscopic esophageal dilation with a historical cohort treated by dilations alone. A total of 11 children received mitomycin-C concurrently with endoscopic dilations. After a median follow-up of 33 months (range 18-72), and a mean number of 5.4 dilations per patient (range 3-11), 8 of 11 patients achieved a resolution of their strictures, 2 patients remained with stenosis, and 1 patient needed a surgical correction. In the control group, 10 patients required an average of 3.7 (range 3-7) total dilations. After a follow-up of 125 months (range 35-266) after the last dilation, strictures in 9 of 10 children disappeared and the remaining patient was symptom free. No dysplasia related to mitomycin-C was demonstrated. There is no benefit in the resolution of the stricture when adding mitomycin-C treatment compared with repeated esophageal dilations alone in historical controls. Further randomized controlled studies and a short- and long-term evaluation of safety are needed.

Tu1375 Mitomycin C Application Improves the Outcome of Highly Refractory and Recurrent Benign Esophageal Strictures

Tu1375 Mitomycin C Application Improves the Outcome of Highly Refractory and Recurrent Benign Esophageal Strictures

Mitomycin C in the Therapy of Recurrent Esophageal Strictures: Hype or Hope?

Esophageal strictures refractory to conservative treatment represent a major problem in children. The application of Mitomycin C to the site of stricture has been introduced, but the experience with this novel approach remains very limited. Systematic review of publications on the topical application of Mitomycin C in children with persistent esophageal stricture. We identified 11 publications including 31 cases. The underlying cause of stricture was caustic ingestion in 19 (61.2%), esophageal surgery in 7 (22.6%), and others in 5 children (16.2%). The median age of the patients was 48 months (range 4 to 276 months). In the majority of cases cotton pledgets soaked in solution of Mitomycin C were applied endoscopically. Various other techniques such as drug-eluting stents were used. Mitomycin C was applied from 1 to 12 times within intervals from 1 to 12 weeks. The concentrations of Mitomycin C varied considerably between 0.1 and 1 mg/mL. After a mean follow-up time of 22 (6 to 60) months complete relief of symptoms was reported for 21 children (67.7%), and 6 (19.4%) had a partial relief. In four children (12.9%) Mitomycin C treatment failed. No direct or indirect adverse effects were reported. The short-term results of topical Mitomycin C application for refractory esophageal stricture reported in the literature are very encouraging. Prospective studies are mandatory to determine the optimal time points, dosage, and modalities of treatment before a recommendation can be given.

Endoscopic Management of Difficult or Recurrent Esophageal Strictures

Endoscopic Management of Difficult or Recurrent Esophageal Strictures