Treatment Of Recurrent Tracheoesophageal Fistula Research Articles

Double-way endoscopic management for the treatment of recurrent tracheoesophageal fistula: A novel approach for a possible solution of the problem?

BackgroundEsophageal atresia (EA) is the most common congenital anomaly affecting the esophagus, and recurrent tracheoesophageal fistula (rTEF) is one of its most serious complications, usually occurring after primary surgical closure in 3–14 % of patients. Endoscopic management involving the topical application of 50 % trichloroacetic acid (TCA) and clipping systems has favorable results and a low incidence of complications. However, it has been reported that multiple applications are necessary to achieve adequate closure. MethodsThis therapeutic study describes a preliminary 5-step double endoscopic approach involving topical application of 50 % TCA and clips such as the OTS/OVESCO System. ResultsThe rTEF was completely closed in three patients (n = 3); in 2/3 of patients, the OTS/OVESCO system was used. Postoperative esophagogram confirmed the obliteration of the defect, and no patient presented with complications during the 3-year follow-up, with complete resolution of respiratory symptoms. ConclusionsThis preliminary study suggests that the 5-step dual endoscopic approach for closure of the rTEF is effective for both symptom resolution and complete closure of the tracheoesophageal communication.

Pleural flaps in the treatment of recurrent tracheoesophageal fistula

A trachea-oesophageal fistula (TEF) is commonly observed in Oesophageal Atresia (EA). Surgical intervention is required to achieve continuity in the digestive tract. Recurrent trachea-oesophageal fistula (rTEF) is a common complication of EA Repair. This paper describes the feasibility of using pleura flaps to treat the mentioned complication. We present 3 cases encountered between 2019 and 2020 in our institution.

Endoscopic management of recurrent tracheoesophageal fistula with trichloroacetic acid in pediatric patients.

Surgical repair of recurrent tracheoesophageal fistula has a high risk of complications. Therefore, various endoscopic techniques have been used to avoid complications. To understand the usefulness of trichloroacetic acid endoscopic application for the treatment of recurrent tracheoesophageal fistula. An observational, descriptive, retrospective, case-series-based study was carried out in a tertiary pediatric hospital. Records of patients with recurrent tracheoesophageal fistula from 2015 to 2021 were reviewed. All patients within this period underwent brushing and trichloroacetic acid application. Mean time of recurrent tracheoesophageal fistula occurrence was 4.8 months (range: 1-19.2). Two patients had a small fistula (less than 4 mm), three patients had a medium fistula (4 mm), and two patients had a large fistula (more than 4 mm). Mean sessions for fistula closure were 2.2 (range: 1-4). Mean time between procedures was 22 days (range: 14-30). Mean follow-up since fistula closure confirmation was 33 months (range: 9-72), during which no recurrences were noted. Endoscopic management of recurrent transesophageal fistula with trichloroacetic acid is a safe and effective procedure. Brushing and trichloroacetic acid combined improve success rates. Fistulas over 4 mm in diameter require more procedures. However, a larger patient cohort and a longer follow-up period are needed to confirm this.

Posterior Tracheopexy Leads to Long-Term Zero Recurrence Rate after Surgical Treatment of Recurrent Tracheoesophageal Fistula

Posterior Tracheopexy Leads to Long-Term Zero Recurrence Rate after Surgical Treatment of Recurrent Tracheoesophageal Fistula

DOZ047.91: Bronchoscopic treatment of recurrent tracheoesophageal fistula: is it an effective option?

Abstract Purpose Despite technical and surgical improvements, treatment of recurrent tracheoesophageal fistula (rTEF) still remains a challenging problem in pediatric patients. Bronchoscopic closure of rTEF using different agents is described with different success rates in the literature. This study aimed to report results of patients with rTEF treated with chemocauterization using trichloroacetic acid (TCA) and with laser cauterization (LC) followed by fibrin glue (FG) application. Methods Nine patients with rTEF were included in the study from 2014 to 2018. Four patients underwent fistula closure with LC followed by FG application, while another four patients had chemocauterization with TCA. In one case both agents were used. Patients were checked for the success of the treatment by bronchoscopy. All patients had the diagnosis of rTEF. Seven patients had EA with distal TEF and the remaining two patients had H-type TEF as primary pathologies. FG application was performed by LC followed by injection of FG into the fistula. Application of the TCA was made by a TCA-soaked sponge for 30 seconds and 3 times each trial. Results Nine children of the age range 4 months to 5 years (mean 1.5 year) were treated endoscopically. Follow-up ranged between 3 months and 5 years (mean 28 months). Among the nine patients only in one patient with only laser coagulation with FG application the treatment was successful. In the remaining eight patients all attempts failed. All these patients underwent open surgical closure of the fistula. There were no acute or late complications related to either endoscopic method. Conclusion The results of this study suggest that endoscopic occlusion of recurrent TEF has a low success rate. Surgical closure is still a standard method with a high success rate. Even though endoscopic options are less invasive, they prolong the period of aspiration and may cause increased pulmonary problems.

DOZ047.110: Recurrent tracheoesophageal fistula tracheoscopic chemocauterization with trichloroacetic acid

Abstract Objective The aim of this study was to report the experience of two centers in the treatment of recurrent tracheoesophageal fistula (RTEF), by tracheoscopic chemocauterization with trichloroacetic acid (TCA). A surgical approach to RTEF has high morbidity and mortality. Some endoscopic techniques have been developed but nevertheless, optimal treatment is still not determined because of the low number of patients, short term of follow-up, and different techniques. Materials and Methods From January 2016 to March 2019, 12 patients with RTEF were selected for endoscopic management in two centers. Eleven had RTEF after primary repair of esophageal atresia/TEF and one had a second fistula with misdiagnosis, all of them by a thoracotomy approach. In all cases the diagnosis was confirmed by clinical evaluation, esophagram, and bronchoscopy. Under general anesthesia, a rigid pediatric bronchoscope with a 0° rod lens telescope telemonitoring was used to localize and refresh the fistula with a small endoscopy brush of 2–3 mm. Cotton soaked with 50% TCA was applied on the fistula for 30 seconds. The procedure had to be repeated two times. Results Fistulae were closed in 10 patients. The closure was confirmed by esophagram or bronchoscopy after 2 months of the procedure. It remains completely obliterated and the patients are asymptomatic. There were only two patients with progressive decrease in the diameter of the fistula; one patient died for some other medical reason and another patient is being treated. The mean number of procedures in each patient was 1.3, and the follow-up was 12 months on average (2–36). Two patients had bronchospasms as postoperative complication. Conclusion The tracheoscopic chemocauterization of RTEF with the use of 50% TCA is a minimally invasive, safe, and effective technique. It has fewer complications and avoids the morbidity of open surgery.

Usefulness of dextranomer/hyaluronic acid copolymer in bronchoscopic treatment of recurrent tracheoesophageal fistula in children

Objective Endoscopic repair of recurrent tracheoesophageal fistula (RTF) in infants who underwent surgery at birth for esophageal atresia (EA) is under investigation as an alternative to open surgery, which is technically challenging and associated with high morbidity. The aims of this paper are to present the experience of a single institution in treating RTF using a novel submucosal bronchoscopic injection of biocompatible dextranomer/hyaluronic acid (Dx/HA) copolymer, and to discuss the indications and limitations of this technique. Methods From 2000 to 2007, 6 children (2 boys; 4 girls) aged 1–48 months, weighing 2.5–18 kg were referred to our hospital for respiratory symptoms (pneumonia and failure to thrive) secondary to suspected RTF. All infants had undergone surgery at birth for EA with inferior tracheoesophageal fistula. Bronchoscopy revealed that five infants had RTF and one had a large remnant tracheal upper-pouch fistula. The bronchoscopic intervention was performed under general anesthesia, using a pediatric rigid bronchoscope with a 0° telescope and telemonitoring. The fistula wall mucosa was gently abraded to promote adhesion, and Dx/HA was then injected at two points in the fistula submucosa to obtain a stable swelling of the wall and closure of the RTF. Results In two infants (aged 1 month and 18 months) complete resolution of the RTF was achieved following two separate procedures with a 1-month interval. In three children (aged 2, 18 and 25 months) complete closure of the fistula was not achieved; however, the partial closure was sufficient to address the respiratory symptoms and allow subsequent standard open thoracic surgery without requiring recovery in the intensive care unit. Complete resolution of respiratory symptoms was also obtained following a single endoscopic procedure with two Dx/HA injections in the child with residual pouch fistula. Conclusion Bronchoscopic treatment of RTF with Dx/HA is a simple, minimally invasive, low-risk procedure that enables complete closure of RTF or reduction and resolution of respiratory symptoms, which in turn facilitates uncomplicated thoracic surgery. The technique also provides good results in remnant tracheal upper-pouch fistula.

Usefulness of large pleural flap for the treatment of children with recurrent tracheoesophageal fistula

Recurrent tracheoesophageal fistula (RTF) complicates 5-11% of cases of children treated at birth for esophageal atresia with inferior tracheoesophageal fistula (ITF), and it represents an important problem of respiratory morbility and mortality. Surgical correction of RTF is complex with high incidence of recurrence. The aim of this work is to demonstrate the usefulness of large vascularized pleural flap in the treatment of RTF and the prevention of recurrences. From 2000 to 2007, four children (3 males and 1 female) referred to our hospital for respiratory symptoms secondary to RTF. Diagnosis of RTF was made by bronchoscopy and esophagogram with contrast medium. Operative repair involved resection of the fistula, suture of trachea and esophagus followed by interposition of large vascularized pleural flap (PF). There were no complications during surgical procedure and after 48 h, with easy respiratory weaning after 24 h. Hospital discharge ranged from 5 to 10 days. Long-term follow-up (range 18 months-5 years) demonstrated no evidence of recurrences. Large vascularized PF to closure RTF is a highly effective and physiologic method for preventing second recurrences.

P-082 Endoscopic treatment of recurrent tracheoesophageal fistula with argon plasma coagulation : A case report(Poster Session Esophagus, stomach 1,Better Life for Sick Children, Better Future for Pediatric Surgery,the 45th Annual Meeting of Japanese Society of Pediatric Surgeons)

P-082 Endoscopic treatment of recurrent tracheoesophageal fistula with argon plasma coagulation : A case report(Poster Session Esophagus, stomach 1,Better Life for Sick Children, Better Future for Pediatric Surgery,the 45th Annual Meeting of Japanese Society of Pediatric Surgeons)

Long-term assessment of the treatment of recurrent tracheoesophageal fistula with fibrin glue associated with diathermy

Purpose Recurrent tracheoesophageal fistula (RTF) is a serious common complication of the surgical treatment of esophageal atresia. We report the results of our technique of bronchoscopic treatment of RTF with fibrin glue (Tissucol), with a follow-up of over 1 decade. Methods A retrospective review between 1993 and 2004 was conducted, including all patients diagnosed with RTF and treated bronchoscopically with Tissucol, with over 1 year of follow-up. The procedure was implemented under general anesthesia using a rigid neonatal bronchoscope. A magnification chamber and previous diathermia using a urethral catheter were used in the latter 4 patients. The fibrin glue was injected through a clear catheter. The number of endoscopic sessions per patient was limited to 3. Results Seven patients were treated, with evidence of fistular closure in 6 (85%). One patient with satisfactory results, but a follow-up of 4 months, was not included. The age at bronchoscopy ranged from 14 to 20 days (mean, 16.7 days), and a total of 12 sessions were required (mean, 1.7). In the latter 4 patients, diathermia was associated with good results in all and a lower number of sessions (mean, 1.5). All patients were evaluated clinically and radiologically, and a control endoscopy was performed in 4 patients. The follow-up lasted from 2 to 11 years (mean, 7.4 years). Conclusions Because we started to use Tissucol (1994), other authors have reported successful isolated cases, but a relatively large series and a long-term follow-up were lacking. We consider that the success of the procedure depends on several technical factors such as an early diagnosis, before epithelium is formed in the fistula, and the use of initial diathermia, associated in the latter 4 patients. The results obtained with 85% success with a follow-up over 1 year show that the fibrin adhesive is the reference substance for the treatment of RTF; we recommend its endoscopic application associated with diathermia as initial measure.

Endoscopic treatment of tracheoesophageal fistula using electrocautery and the Nd:YAG laser

Background: Endoscopy is a well-established means of diagnosis in recurrent and congenital H-type tracheoesophageal fistulas. There is only limited knowledge of its role in the treatment using either electrocautery or laser. Laser application has not yet been reported in the treatment of recurrent tracheoesophageal fistula. Methods: From 1993 to 1997 five patients with tracheoesophageal fistula (two congenital H-type and three recurrent) were treated endoscopically using a rigid ventilating bronchoscope. The final diagnosis was made on bronchoscopic examination. In two of the patients with recurrent fistulas and one with congenital fistula, the mucosal lining was fulgurated with electrocautery via an insulated wire. In one patient each with recurrent and congenital fistula, the mucosal lining was vaporized with the Nd:YAG laser via a 600 μm bare quartz fiber. Results: Obliteration of the fistula was achieved in both the patients in whom laser was used, but it was unsuccessful in two of the three children in whom electrocautery was used. The obliquity of the congenital H-type fistula renders it more amenable to obliteration compared with the short and direct recurrent fistula. There was significant respiratory distress in the postoperative period after use of electrocautery. However, it was uneventful with the use of laser. Conclusions: Endoscopic treatment of recurrent and congenital H-type tracheoesophageal fistula is technically easier than open surgical procedures and helps avoid the risks associated with the latter. The Nd:YAG laser is qualitatively better than electrocautery for the obliteration of the fistula.