Topical mitomycin C application versus intralesional corticosteroid injection in the management of caustic esophageal strictures in pediatrics: A randomized controlled trial.

BACKGROUND

Caustic esophageal strictures in children are difficult to manage and often require multiple endoscopic dilatation sessions or esophageal replacement. Although topical mitomycin C (MMC) treatment and intralesional corticosteroid injection have been suggested as adjuvant therapy to enhance results, there is currently little comparative data in pediatrics.

METHODS

We conducted a prospective randomized controlled trial including 38 pediatric patients with caustic esophageal strictures requiring endoscopic dilatation. Patients were randomly assigned to receive either an intralesional triamcinolone injection (n = 16) or a topical MMC application (n = 22) in conjunction with dilatation. The outcomes included improvement in dysphagia score, endoscopic and radiological findings, procedure-related complications, and the overall number and frequency of dilatations. Subgroup analysis was performed for short (≤3 cm) and long (>3 cm) strictures.

RESULTS

At the conclusion of the research period, MMC treatment demonstrated a clinically significant decrease in the frequency of dilatation in short strictures (every 24 weeks compared to 15 weeks in the steroid group), but this did not achieve statistical significance. In long strictures, MMC application significantly reduced dilatation frequency at the end of the study period (every 10 weeks vs. 3 weeks; p < 0.05). Complications included esophageal perforation in 0.27 % per dilatation session. Esophageal replacement was required in 16.2 % of patients.

CONCLUSION

By decreasing the number of dilatation sessions, topical MMC administration is more successful than corticosteroid injection, particularly for long caustic strictures. To validate these results, larger multicenter trials with longer follow-up are recommended.