My understanding, you basically have 2 options to achieve the same thing. For current applications using MSDTC you have these 2 options to migrate them to the Azure cloud, and one option does not exclude the other.
For using the elastic distributed transactions you need to meet 3 specific requirements: .NET application, ADO. NET and the library.
If your application does not meet all those options you have Managed instance distributed transactions using T-SQL. You application does not need to meet any requirements, you only need to move the database to an Azure Managed Instance.