Prognostic factors for success of topical mitomycin c application with endoscopic dilatation on caustic esophageal strictures

Background
Caustic ingestion is still a difficult medical problem, and the outcome is often unexpected. Caustic esophageal strictures are mainly managed by serial esophageal intraluminal dilation. However, when applied in isolation, it may not reach the necessary diameter for significant symptom improvement, so there is an unmet need to evaluate novel treatments, such as topical mitomycin C (MMC).
Aim
The main aim of this study was to assess the prognostic factors for success of topical MMC application with endoscopic dilatation on caustic esophageal strictures.
Patients and methods
This prospective study was conducted on patients with postcorrosive esophageal stricture with a recent history of corrosive ingestion attending Pediatric Surgery Departments in Ain Shams University and Minia University Pediatric Hospitals in the period between January 2019 and December 2020. Endoscopic dilatation followed by MMC application was done in all patients. Prognostic factors such as age, sex, type of the caustic substance, dysphagia score, site of stricture, length of stricture, need for gastrostomy, need for admission in the ICU in the acute stage, laboratory data abnormalities in the acute stage (complete blood picture and arterial blood gases), number of dilatations needed, and the required numbers of dilatations per month [periodic dilatation index (PDI)] were studied in all patients. The patients were followed up for at least 1 and a half years after the start of dilatation.
Results
During the specified time periods, 24 patients presented to Pediatric Surgery Departments in Ain Shams University and Minia University Pediatric Hospitals. The patients’ ages ranged from 2 to 10 years. There were 14 (58.3%) males and 10 (41.7%) females. In 66.7% of cases, the caustic agent was alkaline, whereas it was acidic in 33.3% of cases. The mean dysphagia score improved from 3.54 ± 0.5 to 0.79 ± 0.66. The site of stricture was at the middle esophagus in 20 (83.3%) cases, whereas four (16.7%) cases had stricture in the lower esophagus. The length of stricture was more than or equal to 3 cm in 58.3% of cases, whereas 41.7% of cases had length less than 3 cm. Two (8.3%) patients needed gastrostomy. A total of 17 (70.8%) children were admitted in the ICU toxicology at acute stage, whereas seven (29.2%) children were not. The mean hemoglobin level was 10.27 g/dl, the mean total leukocytic count was 11.78 cell/mm, the mean platelets count was 353 235.29 cell/mm, the mean pH was 7.464, and the mean PCO was 35.0 mmHg. The mean number of dilatations was 12.63 ± 3.12 and ranged from 7 to 19. The mean PDI in the studied cases was 0.64 ± 0.14 and ranged from 0.4 to 1.0. Overall, we found that 21 (87.5%) cases showed clinical improvement, whereas three (12.5%) cases did not improve. There was a significant correlation between the PDI and the success of MMC application with endoscopic dilatation, whereas there was no significant correlation between success and other prognostic factors.
Conclusion
Low PDI is a good prognostic factor for success of topical MMC application with endoscopic dilatation on caustic esophageal stricture.