EFFICACY OF ENDOSCOPIC TOPICAL MITOMYCIN C APPLICATION IN CAUSTIC ESOPHAGEAL STRICTURES IN THE PEDIATRIC POPULATION: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Aims Caustic ingestion and consequential esophageal strictures constitute a significant health problem in childhood. Multiple sessions of endoscopic dilatation are usually required to manage caustic esophageal strictures. Recently, the application of topical mitomycin C as an adjuvant treatment with endoscopic dilatation therapy has shown promising results in improving symptoms and decreasing the number of dilation sessions. We aimed of this study is to evaluate the efficacy of endoscopic topical mitomycin C application in the treatment of caustic esophageal strictures in the pediatric population.

Methods We searched MEDLINE, EMBASE, Central Cochrane, and LILACS databases, as well as the gray literature, to identify RCTs comparing topical mitomycin C application with endoscopic dilations and endoscopic dilations alone for treatment of caustic esophageal strictures in pediatric patients. The outcomes evaluated were dysphagia resolution rate, number of dilations performed in resolved cases, and the number of dilations performed in all patients.

Results Search results yielded a total of 534 records. Out of these, three RCTs with 190 patients were included for the final analysis. All dilations were performed using semiflexible thermoplastic bougies. Topical mitomycin C application group showed a significant increase in dysphagia resolution rate, corresponding to a 42% higher dysphagia resolution as compared to endoscopic dilation alone (RD 0.42 (95%CI: 0.29-0.56); p-value < 0.00001). The mean number of dilations performed in resolved cases were significantly less in the topical mitomycin application group compared to endoscopic dilations alone (MD: 2.84 (95%CI 1.98-3.69); p-value < 0.00001). Comparing the number of dilations in all patients, there was no statistical difference (MD: 1.46 (95%CI 1.53-4.44); p-value = 0.34).

Conclusions Application of topical mitomycin C with endoscopic dilations in caustic esophageal strictures was more effective in dysphagia resolution than endoscopic therapy alone in the pediatric population. Moreover, topical mitomycin C application also reduced the number of dilatation sessions needed to alleviate dysphagia.