Endoscopic closure of recurrent tracheoesophageal fistula using argon plasma coagulation: A case report

Abstract

Recurrent tracheoesophageal fistula (RTEF) after surgical repair of esophageal atresia remains a serious complication. Open surgical repair for RTEF is associated with high levels of postoperative morbidity, mortality and repeat recurrence. Although endoscopic management has been expected to be an alternative to re-surgery, the optimal endoscopic management of RTEF remains to be determined. This report describes a successful experience of argon plasma coagulation (APC) for the closure of an intractable RTEF. A newborn male diagnosed as having esophageal atresia with tracheoesophageal fistula (TEF) underwent a primary surgical repair. At 17 months of age, an oral contrast study showed the recurrence of the TEF, and subsequently he underwent a second open surgery. However, a postoperative esophagogram revealed a second recurrence of the TEF. Then, endoscopic treatment options were considered and APC was employed to coagulate the fistula epithelium. At 31 months of age, APC followed by fibrin glue application was performed. By this procedure the RTEF could be occluded safely and successfully without any complications. APC is a simple, safe and effective procedure, and is therefore worth trying as a first attempt for the treatment of RTEF.