Topical mitomycin-C for recalcitrant esophageal strictures: a novel endoscopic/fluoroscopic technique for safe endoluminal delivery

BackgroundNonsurgical treatment of recalcitrant pediatric esophageal strictures is challenging. The chemotherapy drug mitomycin-C, which reduces collagen synthesis and scar formation, shows anecdotal promise in the topical treatment of these strictures. Mitomycin-C is cytotoxic, and a safe endoluminal delivery system that avoids inadvertent application to adjacent mucosa has not yet been described.DiscussionWe have treated 2 patients with a combined endoscopic/fluoroscopic technique that ensures protected delivery of a mitomycin-soaked pledget directly to the targeted site.Following pneumatic balloon dilation of the stricture under fluoroscopy, flexible esophagoscopy is performed to the disrupted stricture. Through the gastrostomy tract, a 12F to 16F semirigid sheath is introduced over a guide wire and passed retrograde up the esophagus to the stricture. A grasping forceps introduced through the instrument channel of the esophagoscope is advanced through the sheath and grasps a mitomycin-C–soaked pledget. The pledget is drawn back through the sheath up to the stricture where timed, serial radial applications to the stricture are performed without any contamination of the rest of the esophagus or stomach.ConclusionWe describe a novel technique of endoluminal delivery and focused application of mitomycin-C to an esophageal stricture that avoids inadvertent topical application to adjacent mucosa.