Adjunctive topical mitomycin C during endoscopic dilation for pediatric caustic esophageal stricture: a systematic review and meta-analysis of randomized controlled trials.
Judith Mura Gamarra, Maurício Prätzel Ellwanger, Lorenna Lim et al.
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In 30 seconds
This systematic review and meta-analysis assessed topical mitomycin C (MMC) added to endoscopic dilation for caustic esophageal stricture in children. Three randomized controlled trials involving 221 children were pooled. Compared with dilation alone, adjunctive MMC was associated with higher odds of dysphagia resolution (OR 7.82; 95% CI 4.17-14.65; I²=0%) and fewer dilation sessions (MD - 3.01; 95% CI - 3.30 to - 2.73; k = 2; I²=0%). No MMC-attributable adverse events were reported across 110 pooled MMC exposures. The authors note that multicentre trials with longer follow-up are still needed.
Key findings
- MMC was associated with higher odds of dysphagia resolution than dilation alone (OR 7.82; 95% CI 4.17-14.65; I²=0%).
- In two trials, MMC was associated with fewer dilation sessions (MD - 3.01; 95% CI - 3.30 to - 2.73; k = 2; I²=0%).
- No MMC-attributable adverse events occurred across 110 pooled MMC exposures.
Why it matters
Caustic esophageal strictures can require repeated dilation, creating a substantial treatment burden for children. The pooled randomized evidence suggests that topical MMC alongside dilation may improve dysphagia resolution while reducing the number of procedures. These findings are clinically relevant but should be interpreted in light of the limited trial base and the authors’ call for longer follow-up.
What to keep in mind
Only three pediatric RCTs were pooled, and dilation-session results came from two trials. The authors state that multicentre RCTs with longer follow-up are needed.