Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - HC/FMUSP, Unidade de endoscopia gastrointestinal, São Paulo, SP, Brasil.
Arq Gastroenterol. 2021 Apr-Jun;58(2):253-261. doi: 10.1590/S0004-2803.202100000-38.
Caustic ingestion and development of esophageal strictures are recognized major public health problems in childhood. Different therapeutic methods have been proposed in the management of such strictures.
To evaluate efficacy and risk of endoscopic topical application of mitomycin C in the treatment of caustic esophageal strictures.
We searched MEDLINE, EMBASE, Central Cochrane, and LILACS databases. The outcomes evaluated were dysphagia resolution rate, number of dilations performed in resolved cases, and the number of dilations performed in all patients.
Three randomized clinical trials were included for final analysis with a total of 190 patients. 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, with statistical significance between the two groups (RD: 0.42 - [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 C application group, compared to endoscopic dilations alone, with statistical significance between the two groups (MD: 2.84 [CI: 1.98-3.69]; P-value <0.00001). When comparing the number of dilations in all patients, there was no statistical difference between the two groups (MD: 1.46 [CI: -1.53-4.44]; P-value =0.34).
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 dilation sessions needed to alleviate dysphagia without rising morbidity.
腐蚀性物质摄入和食管狭窄的发展是儿童中公认的主要公共卫生问题。对于此类狭窄，已经提出了不同的治疗方法。
评估丝裂霉素 C 内镜局部应用治疗腐蚀性食管狭窄的疗效和风险。
我们检索了 MEDLINE、EMBASE、CENTRAL Cochrane 和 LILACS 数据库。评估的结局包括吞咽困难缓解率、缓解病例中进行的扩张次数以及所有患者中进行的扩张次数。
最终纳入了 3 项随机临床试验，共 190 例患者。与单独内镜扩张相比，局部应用丝裂霉素 C 组的吞咽困难缓解率显著提高，对应于 42%的更高吞咽困难缓解率，两组之间具有统计学意义（RD：0.42-[CI：0.29-0.56]；P 值<0.00001）。与单独内镜扩张相比，在缓解病例中进行的平均扩张次数在局部应用丝裂霉素 C 组中明显减少，两组之间具有统计学意义（MD：2.84-[CI：1.98-3.69]；P 值<0.00001）。比较所有患者的扩张次数，两组之间无统计学差异（MD：1.46-[CI：-1.53-4.44]；P 值=0.34）。
与单独内镜治疗相比，在儿科人群中，腐蚀性食管狭窄中应用局部丝裂霉素 C 联合内镜扩张在缓解吞咽困难方面更有效。此外，局部应用丝裂霉素 C 还减少了缓解吞咽困难所需的扩张次数，而没有增加发病率。
