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Adjunctive topical mitomycin C during endoscopic dilation for pediatric caustic esophageal stricture: a systematic
Judith Mura Gamarra1, Maurício Prätzel Ellwanger2, Lorenna Lim3
1Faculty of Medicine, Universidad Católica Nuestra Señora de la Asunción, Asunción, Paraguay. judithv.mura@gmail.com.
Purpose:
Caustic esophageal stricture is a major cause of pediatric dysphagia requiring repeated dilation. We assessed whether adjunctive topical mitomycin C (MMC) improves dysphagia resolution and reduces dilation sessions in children.
Methods:
We searched PubMed, Embase, and Cochrane CENTRAL (inception through May 17, 2026) for randomized controlled trials comparing dilation plus topical MMC with dilation alone in children with caustic esophageal stricture. Risk of bias was assessed with RoB 2 and certainty with GRADE. Random-effects meta-analyses were performed; the single eligible adult RCT was reported narratively.
Results:
Three pediatric RCTs (221 patients; 110 MMC, 111 control) were pooled. 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 occurred across 110 pooled MMC exposures, or 128 including non-pooled controlled evidence. Effects were robust in sensitivity analysis (OR 6.86; 95% CI 3.34-14.10).
Conclusion:
In pediatric caustic esophageal stricture, adjunctive topical MMC improves dysphagia resolution and reduces dilation burden. Multicentre RCTs with longer follow-up remain needed.
Prospero Registration:
CRD420261351544.
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