Faculty Collaboration Database

Endoscopic esophageal and tracheal cauterization for closure of recurrent tracheoesophageal fistula: A case report and review of the literature. Int J Pediatr Otorhinolaryngol 2017 Jul;98:158-161

Date

06/07/2017

Pubmed ID

28583493

DOI

10.1016/j.ijporl.2017.04.051

Scopus ID

2-s2.0-85019436748 (requires institutional sign-in at Scopus site)   18 Citations

Abstract

OBJECTIVE: Recurrent tracheoesophageal fistula (TEF) can be a diagnostic and therapeutic challenge. Traditional treatment is thoracotomy, which carries significant morbidity and technical difficulty especially in a previously operated field. Recently, endoscopic techniques have been advocated as a primary approach for treatment of recurrent TEF prior to open repair. This case report describes the endoscopic technique used to address a recurrent TEF. The existing literature of all reported endoscopic cauterization methods is reviewed.

METHODS: An 8 month old with proximal esophageal atresia and distal TEF underwent endoscopic closure of a recurrent TEF. The fistula was approached endotracheally utilizing Bugbee electrocautery (EC) and endoluminally through the esophagus using argon plasma coagulator and placement of porcine submucosa graft into the tract. Current literature review is presented with a synthesis of data on cases utilizing endoscopically applied EC and the combined results of this closure technique.

RESULTS: Our patient has maintained successful closure after a single treatment confirmed on follow up endoscopy 6 months post repair. Including this patient, there have been 30 patients with recurrent TEF treated utilizing endoscopic EC reported in the literature. The overall success rate is 78.8% with a mean of 1.88 procedures per successful closure. Comparing EC alone to EC combined with tissue glues or laser, success rates are 67% and 86% respectively.

CONCLUSION: Endoscopic repair of recurrent TEF has proven to be safe and effective in the literature as an alternative to a second thoracotomy/open surgical repair. EC combined with tissue glues or laser is more effective than EC alone based on available data.

Author List

Gregory S, Chun RH, Parakininkas D, Amos L, Fons R, Lerner DG, Lal DR, Sulman C

Authors

Louella B. Amos MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Robert H. Chun MD Professor in the Otolaryngology department at Medical College of Wisconsin
Dave Lal MD, MPH Chief, Professor in the Surgery department at Medical College of Wisconsin
Diana Lerner MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Daiva E. Parakininkas MD Associate Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Electrocoagulation
Endoscopy
Esophageal Atresia
Esophagus
Humans
Infant
Male
Retrospective Studies
Thoracotomy
Trachea
Tracheoesophageal Fistula