Joyce C. Zhou, BA1, Kelly E. Hathorn, MD2, Thomas R. McCarty, MD2, Ahmad Najdat Bazarbashi, MD3, Christopher C. Thompson, MD2; 1Harvard Medical School, Boston, MA; 2Brigham & Women's Hospital, Boston, MA; 3Brigham & Women's Hospital, Somerville, MA
Introduction: Management of refractory upper gastrointestinal strictures remains challenging. Despite a variety of available endoscopic therapies, including balloon dilation, incisional therapy, and stent placement, treatment may be ineffective or short-lived with the development of persistent or recurrent symptoms. Topical use of Mitomycin C, a chemotherapeutic agent thought to reduce collagen synthesis and fibrosis, may be considered for severe, refractory strictures. Our aim was to evaluate the safety and efficacy of topical Mitomycin C for patients with refractory upper gastrointestinal stenosis.
Methods: This was a retrospective case series to identify all adult patients who underwent endoscopy with topical application of Mitomycin C for refractory upper gastrointestinal stenosis. Our hospital registry was used to collect specific patient and procedure-related information from 2015 to 2019. Refractory stenosis was defined as any GI stenosis that could not be traversed with an upper endoscope and previous unsuccessful treatment or poor response with conventional endoscopic therapy (i.e., balloon dilation, incisional therapy, or stent placement). Sterile gauze soaked with Mitomycin C were used for topical drug delivery in each scenario. Baseline patient characteristics including age (years), gender, BMI (kg/m2), and etiology of stricture as well as procedure-associated outcomes were extracted. Primary outcome was symptom-free interval between endoscopic interventions. Secondary outcomes included treatment-related adverse events. Discussion: A total of 5 patients were included with baseline patient characteristics shown in Table 1. Mean age at time of first mitomycin application was 67.87 ± 9.84 years. Sixty percent of patients were male with symptoms requiring initial endoscopic treatment occurring at 67.08 ± 9.64 years of age. Patients underwent more procedures without mitomycin than with mitomycin (4.60 ± 2.88 versus 1.40 ± 0.55; P=0.041). Overall, patients underwent 4.2 dilation attempts prior to topical mitomycin therapy. Symptom-free interval and time to reintervention was longer after topical application of Mitomycin C (342.71 ± 470.54 versus 75.43 ± 67.07 days; P=0.010). No patients experienced treatment-related adverse events.
This case series demonstrates that topical application of Mitomycin C can be safely and effectively used to increase the symptom-free interval in patients with severe, refractory upper GI stenosis.
Table 1: Patient Characteristics and Procedure Outcomes
Disclosures: Joyce Zhou indicated no relevant financial relationships. Kelly Hathorn indicated no relevant financial relationships. Thomas McCarty indicated no relevant financial relationships. Ahmad Najdat Bazarbashi indicated no relevant financial relationships. Christopher Thompson: Apollo Endosurgery – Consultant, Grant/Research Support. Aspire Bariatrics – Grant/Research Support. BlueFlame Healthcare Venture Fund – Advisory Committee/Board Member. Boston Scientific – Consultant. Covidien/Medtronic – Consultant. EnVision Endoscopy – Advisory Committee/Board Member. Fractyl – Consultant. GI Dynamics – Consultant, Grant/Research Support. GI Windows – Stockholder/Ownership Interest (excluding diversified mutual funds). Olympus/Spiration – Consultant, Grant/Research Support. Spatz – Grant/Research Support. USGI Medical – Advisory Committee/Board Member, Consultant, Grant/Research Support.