Operative Techniques Topical mitomycin C application is effective in management of localized caustic esophageal stricture: A double-blinded, randomized, placebo-controlled trial Khaled M. El-Asmar a, ⁎ , Mohamed A. Hassan b , Hesham M. Abdelkader a , Alaa F. Hamza a a Department of Pediatric Surgery, Ain Shams University, Cairo, Egypt b Department of Otolaryngology, Ain Shams University, Cairo, Egypt Received 14 January 2013; revised 26 April 2013; accepted 26 April 2013 Key words: Mitomycin C; Caustic esophageal stricture; Endoscopic dilatation Abstract Background: Frequent sessions of endoscopic dilatation are usually required in the management of benign esophageal strictures, especially caustic induced ones. Topical mitomycin C (MMC) has been recently used in the management of resistant strictures. This study evaluated the efficacy of MMC application in prevention of stricture recurrence after endoscopic dilatation. Patients and methods: This double-blind, randomized, placebo-controlled trial included forty patients with caustic esophageal strictures dating from January 2008 to October 2010. Patients were randomized into 2 groups to undergo endoscopic dilatation with application of either MMC versus placebo on stricture site. Regular follow up and re-evaluation were done after 6 months of management. The number of dilatation sessions needed for resolution of dysphagia in each group was our primary outcome. Results: During the specified follow up period, 80 % of strictures in the MMC group got completely resolved compared to only 35% in the placebo group. The mean number of dilatation sessions needed in the MMC group was n = 3.85 ± 2.08 compared to n = 6.9 ± 2.12 in the placebo group which was statistically significant (p b 0.001). Conclusion: Mitomycin C application significantly reduced the number of dilatation sessions needed to alleviate dysphagia in patients with caustic esophageal strictures. © 2013 Elsevier Inc. All rights reserved. Despite increased public awareness and implementation of safety measures, accidental caustic ingestion and consequential esophageal strictures remain a major pediatric health problem worldwide [1]. Treatment of caustic esophageal strictures is challenging, time consuming, and in many cases unsatisfactory [2]. The first line of treatment usually involves repeated dilatation. However, the recur- rence rate is still high [3] and long-term stenting, resection of the stenotic esophageal segments, or esophageal replacement may be needed in resistant cases [4]. Several agents have been proposed in order to increase the success rate of esophageal dilatation such as topical ⁎ Corresponding author. 14 mostafa sadek el-rafeay, Heliopolis, Cairo, Egypt. Tel.: + 2 01001222624. E-mail address: khaled80@hotmail.com (K.M. El-Asmar). www.elsevier.com/locate/jpedsurg 0022-3468/$ – see front matter © 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jpedsurg.2013.04.014 Journal of Pediatric Surgery (2013) 48, 1621–1627