Abstract
Esophageal Ulceration Following Mitomycin C Application for Benign Refractory Stricture
The American journal of gastroenterology, Vol.113(Supplement), pp.S1025-S1026
10/01/2018
DOI: 10.14309/00000434-201810001-01801
Abstract
Refractory caustic esophageal strictures pose a difficult challenge for the practicing gastroenterologist. Current therapeutic options include serial treatment of esophageal strictures with bougie or balloon dilators. However, oftentimes these dilations only provide temporary relief, with eventual recurrence of the strictures. Given the limited therapeutic options, some have suggested using the antitumor antibiotic mitomycin C (MMC) as an adjunctive therapy to dilation. In case reports, MMC has been shown to improve stricture resolution and reduce the number of required dilatations. Currently available literature describes MMC application as overall safe and well-tolerated. However, we describe a case of esophageal ulceration resulting from stricture treatment with MMC. A 71-year-old female with a history of esophageal stricture related to alkali ingestion in 2015, status-post multiple serial dilations, was admitted with recurrent solid food dysphagia. She underwent an esophagogastroduodenoscopy (EGD) that identified recurrence of a 1 cm-long benign stricture at 36 cm from the incisors which was not traversable with the standard gastroscope (Figure 1). Balloon dilation was performed under fluoroscopy up to 17mm, with post-dilation appearance of medium-sized mucosal rents extending from 34-37 cm. Following dilation, a total of 8 cc of MMC was injected in 1 cc aliquots into the esophageal submucosal space in a 4-quadrant fashion at two levels, 34 cm and 36 cm. On follow up EGD at 4 weeks post-injection, a large, deeply cratered 4 cm long ulceration was encountered extending from 34cm to 38cm from the incisors. The ulcer appeared to involve about one-third of the esophageal circumference (Figure 2). Fluoroscopic evaluation with contrast revealed no evidence of perforation. Endoscopy was repeated again at 6 weeks post-injection, with additional granulation tissue noted in the ulcer base. Most recently, an EGD performed again at 8 weeks post-injection demonstrated a nearly healed ulcer base. Technique Highlights: Despite case reports on the safe use of MMC for refractory esophageal strictures, we present a case where MMC induced a large, deep esophageal ulceration following application after dilation. While other studies highlight the benefits of using mitomycin C in terms of resolution of symptoms and reduced number of dilations, our case suggests the possibility of a serious adverse effect and the need for additional studies into the safety profile of MMC.
Details
- Title: Subtitle
- Esophageal Ulceration Following Mitomycin C Application for Benign Refractory Stricture
- Creators
- Rintaro Hashimoto - University of California, Irvine Medical CenterDaniel Mai - University of California, Irvine Medical CenterEricson Torralba - University of California, Irvine Medical CenterAllen Yu - University of California, Irvine Medical CenterDavid Lee - University of California, IrvineJason Samarasena - University of California, Irvine Medical Center
- Resource Type
- Abstract
- Publication Details
- The American journal of gastroenterology, Vol.113(Supplement), pp.S1025-S1026
- Publisher
- Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
- DOI
- 10.14309/00000434-201810001-01801
- ISSN
- 0002-9270
- eISSN
- 1572-0241
- Language
- English
- Date published
- 10/01/2018
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984697045802771
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