Submitted to: Journal of Pediatric Surgery
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/10/2005
Publication Date: 5/7/2006
Citation: Olutoye, O.O., Shulman, R.J., Cotton, R.T. 2006. Mitomycin C in the management of pediatric caustic esophageal strictures. A case report. Journal of Pediatric Surgery. 41:E1-E3. Interpretive Summary: Unfortunately young children often have access to chemicals that are extremely caustic. Toddlers especially are likely to drink liquids from containers without knowledge of the contents. Caustic liquids, particularly those that are alkaline can cause severe injury to the esophagus leading to scarring to the point where the esophagus closes off. The treatments for these scars are not optimal. The authors describe the use of a medication that shows promise in reducing the scarring caused by caustic chemicals.
Technical Abstract: Although the incidence of caustic ingestion is declining, the management of caustic esophageal strictures remains a challenge. Mitomycin C (MMC) inhibits fibroblast proliferation and is effective in reducing scar in animal experiments. We report the case of a child with a distal esophageal stricture from lye ingestion managed with MMC. Despite repeated dilatations, at 1 year post injury, the stricture was 20% of esophageal diameter. Mitomycin C (4lg/mL) was applied topically and circumferentially by endoscopy and repeated 4 months later. At 20 months follow-up, the child eats normally, and esophagram showed decreased stenosis (stricture was 50% of esophageal diameter). No complications were observed. Although controlled trials are required to confirm its efficacy, MMC should be considered as an adjunct in the management of caustic esophageal strictures in children.