Pathological Study of Tracheal and Pulmonary Lesions in Autopsy Cases of Congenital Esophageal Atresia

Maeta, T.; Fujiwara, Yoshiyuki; Ohizumi, Tetsunosuke; Kato, Eiichi; Kakizaki, G

doi:10.1620/tjem.123.23

Cited by 5 publications

(6 citation statements)

References 5 publications

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“…Further deterioration of the TM may ensue postrepair, from recurrent tracheal inflammation due to aspiration and infection, or due to tracheal wall weakness secondary to prolonged intubation and long-term mechanical ventilation. 27,28,[30][31][32][33] Intermittent dilatation of the esophagus due to bolus obstruction can easily overcome the resistance of the weakened tracheal wall and cause its further collapse. 34,35 Complications attributed to TM are:…”

Section: Respiratory Pathophysiologymentioning

confidence: 99%

Care recommendations for the respiratory complications of esophageal atresia‐tracheoesophageal fistula

Koumbourlis

Belessis

Cataletto

et al. 2020

Pediatric Pulmonology

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Tracheoesophageal fistula (TEF) with esophageal atresia (EA) is a common congenital anomaly that is associated with significant respiratory morbidity throughout life. The objective of this document is to provide a framework for the diagnosis and management of the respiratory complications that are associated with the condition. As there are no randomized controlled studies on the subject, a group of experts used a modification of the Rand Appropriateness Method to describe the various aspects of the condition in terms of their relative importance, and to rate the available diagnostic methods and therapeutic interventions on the basis of their appropriateness and necessity. Specific recommendations were formulated and reported as Level A, B, and C based on whether they were based on “strong”, “moderate” or “weak” agreement. The tracheomalacia that exists in the site of the fistula was considered the main abnormality that predisposes to all other respiratory complications due to airway collapse and impaired clearance of secretions. Aspiration due to impaired airway protection reflexes is the main underlying contributing mechanism. Flexible bronchoscopy is the main diagnostic modality, aided by imaging modalities, especially CT scans of the chest. Noninvasive positive airway pressure support, surgical techniques such as tracheopexy and rarely tracheostomy are required for the management of severe tracheomalacia. Regular long‐term follow‐up by a multidisciplinary team was considered imperative. Specific templates outlining the elements of the clinical respiratory evaluation according to the patients’ age were also developed.

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Section: Respiratory Pathophysiologymentioning

confidence: 99%

Care recommendations for the respiratory complications of esophageal atresia‐tracheoesophageal fistula

Koumbourlis

Belessis

Cataletto

et al. 2020

Pediatric Pulmonology

View full text Add to dashboard Cite

show abstract

“…Further deterioration of the TM may ensue post-repair, from recurrent tracheal inflammation due to aspiration and infection, or due to tracheal wall weakness secondary to prolonged intubation and long-term mechanical ventilation. 27,28,[30][31][32][33] Intermittent dilatation of the esophagus due to bolus obstruction can easily overcome the resistance of the weakened tracheal wall and cause its further collapse 34,35 . Complications attributed to TM are:…”

Section: Respiratory Pathophysiologymentioning

confidence: 99%

“…11 2. Impaired airway clearance: The narrowing of the tracheal lumen leads to retention of airway secretions whose clearance is further impaired by the loss of cilia on the respiratory epithelial cells at the fistula site 28,33,48 . The retention of secretions predisposes to colonization with bacterial organisms and progressive airway inflammation that may lead to irreversible lung damage, including bronchiectasis.…”

Section: Respiratory Pathophysiologymentioning

confidence: 99%

Care Recommendations for the Respiratory Complications of Esophageal Atresia-Tracheoesophageal Fistula: The International Network of Esophageal Atresia, Respiratory Complications Working Group

Koumbourlis

Belessis

Cataletto

et al. 2020

Preprint

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Tracheoesophageal fistula (TEF) with esophageal atresia (EA) is a common congenital anomaly that is associated with significant respiratory morbidity throughout life. The objective of this document is to provide a framework for the diagnosis and management of the respiratory complications that are associated with the condition. As there are no randomized controlled studies on the subject, a group of experts used a modification of the Rand Appropriateness Method to describe the various aspects of the condition in terms of their relative importance, and to rate the available diagnostic methods and therapeutic interventions on the basis of their appropriateness and necessity. Specific recommendations were formulated and reported as Level A, B, C based on whether they were based on "strong", "moderate" or "weak" agreement. The tracheomalacia that exists in the site of the fistula was considered the main abnormality that predisposes to all other respiratory complications due to airway collapse and impaired clearance of secretions. Aspiration due to impaired airway protection reflexes is the main underlying contributing mechanism. Flexible bronchoscopy is the main diagnostic modality, aided by imaging modalities, especially CT scans of the chest. Non-invasive positive airway pressure support, surgical techniques such as tracheopexy and rarely tracheostomy are required for the management of severe tracheomalacia. Regular long-term follow-up by a multidisciplinary team was considered imperative. Specific templates outlining the elements of the clinical respiratory evaluation according to the patients' age were also developed.

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“…These proportions go up to 47% in patients with the VACTERL association (20–22). Hypoplasia, fusion (horseshoe) or agenesis of the lung (23–29), and structural, innervatory, and epithelial differentiation anomalies of the tracheobronchial tree have been described in this condition (22, 30–33). …”

Section: Epidemiology Of Ea ± Tef and Associated Respiratory Malformamentioning

confidence: 99%

“…Other abnormal tracheal features in EA ± TEF are impaired mucociliary transport due to the replacement of the ciliated epithelium of the trachea by stratified squamous epithelium (33) and abnormal intrinsic tracheal innervation (31), both likely players in the development and chronic nature of some respiratory symptoms.…”

Section: Multifactorial Origin Of Respiratory Tract Disease In Ea ± Tmentioning

confidence: 99%

The Multifactorial Origin of Respiratory Morbidity in Patients Surviving Neonatal Repair of Esophageal Atresia

Fragoso

Tovar

2014

Front. Pediatr.

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Esophageal atresia with or without tracheoesophageal fistula (EA ± TEF) occurs in 1 out of every 3000 births. Current survival approaches 95%, and research is therefore focused on morbidity and health-related quality of life issues. Up to 50% of neonates with EA ± TEF have one or more additional malformations including those of the respiratory tract that occur in a relatively high proportion of them and particularly of those with vertebral, anal, cardiac, tracheoesophageal, renal, and limb association. Additionally, a significant proportion of survivors suffer abnormal pulmonary function and chronic respiratory tract disease. The present review summarizes the current knowledge about the nature of these symptoms in patients treated for EA ± TEF, and explores the hypothesis that disturbed development and maturation of the respiratory tract could contribute to their pathogenesis.

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Pathological Study of Tracheal and Pulmonary Lesions in Autopsy Cases of Congenital Esophageal Atresia

Cited by 5 publications

References 5 publications

Care recommendations for the respiratory complications of esophageal atresia‐tracheoesophageal fistula

Care recommendations for the respiratory complications of esophageal atresia‐tracheoesophageal fistula

Care Recommendations for the Respiratory Complications of Esophageal Atresia-Tracheoesophageal Fistula: The International Network of Esophageal Atresia, Respiratory Complications Working Group

The Multifactorial Origin of Respiratory Morbidity in Patients Surviving Neonatal Repair of Esophageal Atresia

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