Management of Recurrent Tracheoesophageal Fistulas: A Systematic Review

Aworanti, Olugbenga Michael; Awadalla, Sami

doi:10.1055/s-0034-1370780

Cited by 62 publications

(23 citation statements)

References 46 publications

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“…In a systematic review of 165 patients across 44 studies [5], the success rate of surgery was found to be 93.5% compared with 84% for endoscopic treatment. In our study, patients had either failed endoscopic management prior to their referral to our institution or they were too large to be suitable for this approach.…”

Section: Discussionmentioning

confidence: 99%

“…Whereas endoscopic management alone of these has been described [ 7 ], our preference has been to perform surgical repair because of the high risk of recurrence after conservative management. In a systematic review of 165 patients across 44 studies [ 5 ], the success rate of surgery was found to be 93.5% compared with 84% for endoscopic treatment. In our study, patients had either failed endoscopic management prior to their referral to our institution or they were too large to be suitable for this approach.…”

Section: Discussionmentioning

confidence: 99%

“…First, the diagnosis itself can be difficult and often requires oesophageal contrast studies and endoscopies to confirm and intubate the fistula. The literature suggests that a prone oesophagogram whilst withdrawing an NG tube is the most sensitive investigation with the fewest false negatives [ 5 ]. The most sensitive test in our experience has been to perform bronchography with bronchoscopic (B&B) probing of the fistula pit.…”

Section: Introductionmentioning

confidence: 99%

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The multi-disciplinary management of complex congenital and acquired tracheo-oesophageal fistulae

et al. 2018

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Aim of the studyComplex tracheo-oesophageal fistulae (TOF) are rare congenital or acquired conditions in children. We discuss here a multidisciplinary (MDT) approach adopted over the past 5 years.MethodsWe retrospectively collected data on all patients with recurrent or acquired TOF managed at a single institution. All cases were investigated with neck and thorax CT scan. Other investigations included flexible bronchoscopy and bronchogram (B&B), microlaryngobronchoscopy (MLB) and oesophagoscopy. All cases were subsequently discussed in an MDT meeting on an emergent basis if necessary.Main results14 patients were referred during this study period of which half had a congenital aetiology and the other half were acquired. The latter included button battery ingestions (5/7) and iatrogenic injuries during oesophageal atresia (OA) repair. Surgical repair was performed on cardiac bypass in 3/7 cases of recurrent congenital fistulae and all cases of acquired fistulae. Post-operatively, 9/14 (64%) patients suffered complications including anastomotic leak (1), bilateral vocal cord paresis (1), further recurrence (1), and mortality (1). Ten patients continue to receive surgical input encompassing tracheal/oesophageal stents and dilatations.ConclusionsMDT approach to complex cases is becoming increasingly common across all specialties and is important in making decisions in these difficult cases. The benefits include shared experience of rare cases and full access to multidisciplinary expertise.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The multi-disciplinary management of complex congenital and acquired tracheo-oesophageal fistulae

et al. 2018

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“…Reoperation against recurrent TEF is usually done with the interposition of the surrounding soft tissues such as the pleura, pericardium, and muscle flaps [ 2 , 7 ]. However, up to 21% of cases, experience refistulization with mortality rates reaching approximately 4% [ 2 , 4 , 6 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Post-esophageal atresia repair double acquired tracheoesophageal fistulas treated successfully by gastric transposition: a case report

et al. 2020

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Background Postoperative recurrence of tracheoesophageal fistula (TEF) is a frequent complication in the repair of esophageal atresia (EA). Based on the recent etiologic classification, a TEF that develops in a different new pathway from the original one is categorized as an acquired TEF. The TEFs that fall into this category have been reported to be refractory and their mechanisms have not been fully understood. Here, we report the complicated case of an acquired TEF derived from mediastinitis after the original TEF repair developed an anastomotic stricture. The TEF contained double fistulas, both towards the right lobe bronchi, and was repaired by gastric transposition through a retrosternal route. Case presentation The patient was diagnosed with Gross C esophageal atresia after birth and underwent tracheoesophageal fistula banding during the neonatal period. He experienced an intractable anastomotic stenosis after surgery which was treated with repeated balloon dilation therapy. By the age of 11 months, he developed a mediastinal abscess that improved with conservative treatment. At 18 months old, a fistula from the esophagus to the right superior lobe bronchus was identified. The patient underwent a right upper lobectomy to resect the fistula. However, at 21 months old, another fistula to the right lower lobe was revealed. An esophageal banding was done to relieve the respiratory symptoms. This was followed by esophagectomy and gastric transposition through the retrosternal route at 26 months old. The patient started rehabilitation and oral intake gradually after surgery. By 3 years after gastric transposition, he could already take blended food orally with the support of small amounts of enteral feeding. Conclusion Cases of TEF derived from severe inflammation have the potential to form a complicated network and lead to recurrence. Surgeons should consider the possibility of multiple tiny fistulas in cases of severe acquired TEF. These may be repaired successfully by gastric transposition through the retrosternal route.

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“…TEF can be managed either surgically (open repair or thoracoscopic) or endoscopically, depending on their etiology, size, anatomy, and patient comorbidities [4]. Surgery is highly invasive and other options are typically investigated before this is undertaken.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic management of tracheoesophageal fistulas

Ramai

Bivona

Latson

et al. 2018

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Tracheoesophageal fistulas (TEF) are pathologic communications between the trachea and esophagus. TEF can lead to significant respiratory distress that may result in lethal respiratory compromise, often due to recurrent and intractable infections. Through the use of endoscopy, some TEF can be successfully repaired using different approaches depending on the size, location, availability, and experience of the treating endoscopist. The aim of this manuscript is to provide an up-to-date review of the endoscopic management of TEF for gastroenterologists.

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Management of Recurrent Tracheoesophageal Fistulas: A Systematic Review

Cited by 62 publications

References 46 publications

The multi-disciplinary management of complex congenital and acquired tracheo-oesophageal fistulae

The multi-disciplinary management of complex congenital and acquired tracheo-oesophageal fistulae

Post-esophageal atresia repair double acquired tracheoesophageal fistulas treated successfully by gastric transposition: a case report

Endoscopic management of tracheoesophageal fistulas

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