Pediatric surgery international
Adjunctive topical mitomycin C during endoscopic dilation for pediatric caustic esophageal stricture: a systematic review and meta-analysis of randomized controlled trials
By Mura Gamarra J, Ellwanger MP, Lim L and 6 others.
Abstract
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).