ABSTRACT

Aim: To compare the outcome of treatment in patients with post-caustic esophageal strictures treated with endoscopic dilatations with versus without topical Mitomycin-C.

Design: The present study was a randomized controlled trial.

Study settings: It was conducted at the Department of Gastroenterology, Mayo Hospital Lahore over 2 years from January 2019 to December 2020.

Methods: Sixty consecutive patients of both genders aged between 18-60 years presenting with esophageal strictures resulting from caustic injury were included after written informed consent. These patients were randomly allocated into 2 treatment groups. Patients in Group-M underwent application of topical Mitomycin-C and dilatations while those in Group-P underwent topical application of placebo and dilatations. Outcome was measured in terms of successful resolution of dysphagia and total no. of endoscopic-dilatation sessions required in each group.

Results: In the present study, the mean age of the study participants was 32.5±11.4 years. There were 34(56.7%) female and 26 (43.3%) male patients with a female to male ratio of 1.3:1. The combined treatment of topical Mitomycin-C and dilatations was associated with significantly higher success rate (86.7% vs. 43.3%; p-value<0.001) and lesser mean no. of dilatation sessions (3.40±1.04 vs. 6.73±2.29; p-value<0.001) regardless of patient’s age and gender.

Conclusion: Combining topical Mitomycin-C with endoscopic dilatations was found to improve early outcome among patients with esophageal strictures resulting from caustic injury which advocates the preferred use of this novel approach in future surgical practice.

Keywords: Esophageal Strictures, Caustic Injury, Mitomycin-C, Dilatations