Sa2002 THE CLINICAL EFFICACY OF ENDOSCOPIC POSTDILATION INTRALESIONAL INJECTION OF MITOMYCIN-C IN ADULT PATIENTS WITH REFRACTORY BENIGN ESOPHAGEAL STRICTURE

Refractory benign esophageal stricture (RBES) still remains as a clinical challenge, even though repeated endoscopic therapies with bougie or balloon dilation has clinically been tried. Intralesional Mitomycin-C (MMC) injection has recently been introduced to resolve it mostly in children. The aim of this study was to evaluate the clinical efficacy of endoscopic postdilation intralesional injection of MMC in adult patients with RBES. The patients who had RBES even after five or more sessions of bougination were prospectively enrolled. A submucosal needle injection of 4mL of a MMC preparation (0.5mg/mL) was endoscopically done with a 0.5mL of eight each injection mainly into the tearing esophageal wall, after esophageal bougie dilation had done up to 14mm in diameter. Additional therapy of bougination alone or combined with MMC injection was done, if dysphagia symptoms recurred with dysphagia score 3 or more. It was considered as treatment failure if there was no clinical improvement even after 3 additional MMC injections with the interval of 8 weeks. Initial and overall clinical success rates were evaluated with drug- and procedure-related complication rates during the follow-up period of at least 12 months after last MMC injection. Thirteen of 16 patients enrolled in this study were evaluated except 3 patients who had been dropped out. The causes of esophageal stricture were post-operative stricture in 6, corrosive in 5, post-ESD in 1, and peptic in 1 patient. The lengths of stricture were less than 1cm in 5 and longer than 5cm in 2 patients. In 7 patients, GOOSS scores were significantly improved after single MMC injection and consistently kept without further treatments during follow-up period (median, 369 days) with 53.8 % (7/13) of initial clinical success rate. Of the remaining 6 patients, additional MMC injections were performed once more in 3, 2 more in 1, and 3 more times in 2 patients during follow-up, resulting in significant improvement of dysphagia in 4 patients out of them with 84.6% (11/13) of overall clinical success rate. Two patients who failed in achieving overall clinical success after 3 more MMC injections had longer stricture than 5cm in length. The major drug- and procedure-related complications did not occur in any patients during follow-up. Endoscopic postdilation intralesional injection of MMC was safe and effective in adult patients with RBES, especially whom shorter length (<5cm) of esophageal stricture exist.