Pediatric ingested foreign body, acquired tracheoesophageal fistula – Endoscopic repair with cautery &amp; fibrin glue (Tisseel): Case report and literature review

Lao, Victoria Valinluck; Lustig, D D; Boseley, Mark E.; Lao, Oliver B.

doi:10.1016/j.epsc.2015.08.010

Cited by 3 publications

(5 citation statements)

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“…For the management of esophageal FB and BB, emergent rigid or flexible endoscopic removal along with an assessment of the esophageal injury, preferably within 2 h of ingestion, is the primary treatment [ 2 , 4 , 6 ]. Surgical intervention in cases of BB ingestion is mainly reported for the treatment of complications, but in very few cases, where the FB or BB was difficult and failed to be removed endoscopically due to trans-mural impaction or migration as in our case, neck exploration and battery removal through surgical cervical approach were reported as another modality of treatment [ 1 , 10 ]. Lisi et al reported surgical removal of a BB in 2 asymptomatic female patients ages 26 and 29 months, who presented within 4 h of witnessed battery ingestion.…”

Section: Discussionmentioning

confidence: 99%

“…Lao et al reported successful use of subsequent application of electrocautery and fibrin glue as a combined modality in a 33-month-old female with esophageal foreign body-induced tracheoesophageal fistula, where the esophagogram 6 weeks after electrocautery and fibrin glue placement revealed no evidence of tracheoesophageal fistula [ 1 ]. In our case, the surgical repair through the cervical esophagotomy approach had been used to repair the first TEF at the time of battery removal, but the thoracotomy approach was used for the second TEF to provide a wider view and space for the surgical area to allow esophageal mobilization and anastomosis without tension.…”

Section: Discussionmentioning

confidence: 99%

“…Button battery (BB) ingestion is one of the clinical scenarios seen in the pediatric emergency department and it has a significant health risk for the pediatric population, especially in children younger than 6 years of age [ 1 , 2 ]. Worldwide, BB ingestion account for 7–25% of all foreign body ingestion in children [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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A2 Years Old Boy with Recurrent Tracheoesophageal Fistula After Surgical Removal of an Esophageal Button Battery

2022

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Patient: Male, 2-year-old Final Diagnosis: Button battery induced tracheoesophageal fistula and recurrence Symptoms: Cough • difficulty in swallowing • irritability • lethargy • vomiting Medication: — Clinical Procedure: Buttery removal with tracheoesophageal fistula closure through cervical incision • exploration with esophagostomy and gastrostomy • recurrent tracheoesophageal fistula repair and esophageal anastomosis through thoracotomy Specialty: Otolaryngology • Pediatrics and Neonatology • Surgery Objective: Unusual clinical course Background: Among the pediatric population, button batteries ingestion is a significant health risk. The main treatment of ingested esophageal button batteries is urgent endoscopic removal. Missed or delayed diagnosis results in serious complications and outcomes. In the literature, high morbidity and mortality have been described in cases of button battery ingestion. By reporting this case we aim to encourage physicians to raise their suspicion of foreign body ingestion in similar pediatric cases and to review the different management approaches in the case of foreign body-induced tracheoesophageal fistula. Case Report: A 2-year-old boy was referred to us with difficulty in swallowing solids and liquids, with tactile fever for 1 month. A chest X-ray showed a radiopaque foreign body consistent with a button battery. The battery was removed through surgical cervical incision followed by closure of an identified tracheoesophageal fistula, cervical loop esophagostomy, and gastrostomy. After 6 months of follow-up and gastrostomy feeding, recurrence of the tracheoesophageal fistula was identified, for which surgical closure and esophageal anastomosis were performed. A postoperative esophagogram done on day 7 showed no leak or evidence of tracheoesophageal fistula; the patient started oral feeding and the gastrostomy tube was removed. Conclusions: Even in the absence of witnessed ingestion, the persistent nonspecific symptoms must raise the suspicion of foreign body ingestion in the pediatric age group. Failure of endoscopic removal of the battery is a possibility that need to be included in management algorithms. Surgical repair is the most frequently described approach for foreign body-induced tracheoesophageal fistula repair.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A2 Years Old Boy with Recurrent Tracheoesophageal Fistula After Surgical Removal of an Esophageal Button Battery

2022

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“…Adhesives that are used to glue the walls of the fistula together are fibrin glue and n-butyl cyanoacrylate. Fibrin glue is the preferred material of adhesive in many studies in the literature (8)(9)(10)(11)(12)(13)(14). It is a biologic product which creates fibrin clot, and this clot provides haemostasis and sealing (Figure 1A,B).…”

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confidence: 99%

“…De-epithelialization, on the other hand, was provided by diathermy (7,10,12,14,16,21,22), different type of lasers (22,23), argon plasma coagulator (21), mechanical abrasion with brush (8) or forceps (24), and chemocauterization with TCA (25,26) in different papers. In all these techniques, epithelial lining of the fistula was destroyed in order to provide an easy coaptation of both walls of the fistula.…”

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Endoscopic treatment of tracheoesophageal fistula

Kıyan¹

2022

Curr Chall Thorac Surg

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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

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Endoscopic interventional therapies for tracheoesophageal fistulas in children: A systematic review

Ling

Sun²,

Li³

et al. 2023

Front. Pediatr.

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MethodsAn electronic literature search was performed using the keywords “tracheoesophageal fistula,” “endoscopic,” and “children” in the four major medical databases (Ovid, Embase, PubMed, and Web of Science) right from inception to September 2022. All English language articles describing the endoscopic interventional therapies of TEF in children were reviewed. Two independent researchers screened eligible articles at the title and abstract level. Full texts of potentially relevant articles were then screened again, and reference lists were screened manually to identify additional studies. Relevant data were extracted and analyzed. A synthesis of the relevant data was presented in descriptive form because of the heterogeneity of the included articles. The Chi-Squared test was used with a significance level of 5% (P < 0.05).ResultsAmong the 1,167 retrieved papers, a total of 46 studies describing 170 TEF patients with an age range of 0.3–175 months were included, including 11 cases of acquired tracheoesophageal fistula, 144 cases of recurrent tracheoesophageal fistula, and 15 cases of congenital tracheoesophageal fistula (H-type TEF). A total of 119 out of 170 fistulas were successfully blocked via endoscopic techniques with an overall success rate of 70.0%, while 48 fistulas failed to close by endoscopic interventions, following which the procedure was converted to open surgery. No obviously severe intraoperative/postoperative complications occurred during the follow-up period, but only a mild esophageal stricture was noticed in six patients and grade II tracheal stenosis in one patient. Two patients died from causes unrelated to endoscopic procedures, with a mortality rate of approximately 1.2%. A comparative assessment of different endoscopic interventional techniques for TEF that detected endotracheal stenting was performed in six patients and one fistula was successfully blocked (16.7%). De-epithelialization alone was performed in 65 patients and the fistula healed in 47 of them (72.3%), with the mean number of successful treatments required being 2.3 times. Chemical sealant injection was administered in 33 patients and success was achieved in 21 (63.6%). The average requirement for endoscopic procedures was 1.5 times. De-epithelialization, in combination with chemical sealant injection, was performed in 62 patients, achieving the highest success rate of 77.4% (48 patients). Other treatment methods were performed in four patients and successfully treatment outcomes were reported in two of them (50.0%). The mean number of successful treatments required was four times, and a treatment was converted to surgery in one patient (25.0%). An assessment of different TEF types showed that 9 out of 15 congenital TEFs, 7 out of 11 acquired TEFs, and 103 out of 144 recurrent TEFs were successfully occluded. A comparison of the success rate across multiple groups showed a significant difference with a score of P < 0.05, while there was no significant difference in the success rate of different TEF-type groups (P > 0.05).ConclusionEndoscopic intervention is currently a preferred treatment modality for children with TEF because of its less-invasive nature, less complications, and high success rate. Among all interventional techniques, de-epithelialization, in combination with chemical sealant, has a higher success rate than other techniques. However, due to the limited number of cases reported for implementing many kinds of techniques, an ideal endoscopic interventional technique has yet to be devised, often necessitating more treatment applications and close follow-up.

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Pediatric ingested foreign body, acquired tracheoesophageal fistula – Endoscopic repair with cautery & fibrin glue (Tisseel): Case report and literature review

Cited by 3 publications

References 65 publications

A2 Years Old Boy with Recurrent Tracheoesophageal Fistula After Surgical Removal of an Esophageal Button Battery

A2 Years Old Boy with Recurrent Tracheoesophageal Fistula After Surgical Removal of an Esophageal Button Battery

Endoscopic treatment of tracheoesophageal fistula

Endoscopic interventional therapies for tracheoesophageal fistulas in children: A systematic review

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