Endoscopic treatment of tracheoesophageal fistula

Abstract

Tracheoesophageal fistula (TEF) is either congenital or recurrent after a previous TEF repair or iatrogenic after different types of trauma. Recurrent tracheoesophageal fistula (RTEF) is a complication of TEF repair, which is most frequently a component of the surgical treatment (ST) of esophageal atresia (EA) with TEF. RTEF is reported to be between 4.4% and 8% of patients after EA with TEF repair in large series (1,2). Thoracoscopic repair of EA with TEF has gained popularity in the last decade and Iacona et al. reported a recurrence rate of 5.3% in their review of the literature of thoracoscopic repair of EA with distal TEF (3).Recurrent TEF may cause feeding problems and respiratory problems due to aspiration. Thus, RTEF can be detected by radiological or endoscopic methods during assessment of these problems. On the other hand, in some asymptomatic patients TEF can be detected during routine evaluation. Bruch et al. reported a diagnostic period of 2.1 months postoperatively in 24 patients, if two patients in their series, who have periods of five and 18 years, were excluded (2). Since the fistula does not close spontaneously, an intervention is required for management of RTEF. The conventional method for these patients is ST. The most common approach among these surgical techniques is open thoracotomy, which bears significant technical difficulties in the previously operated areas, has a high rate of morbidity, and may occasionally cause death. The hospital stay is long and patient discomfort is noteworthy, if ST is performed. The recurrence rate after surgical closure of a RTEF is