Role of preoperative tracheobronchoscopy in newborns with esophageal atresia: A review

Abstract

Preoperative tracheobronchoscopy (TBS) in the diagnostic assessment of newborns affected by esophageal atresia (EA) was described in 1981. Nevertheless, the value of the procedure is actually much debated; only a few studies have clearly explored the advantages of TBS and this procedure is not yet routinely included in the diagnostic and therapeutic assessment in many international pediatric surgery settings. Routine preoperative TBS is a safe procedure that enables the accurate examination of the tracheobronchial tree, the visualization of tracheoesophageal fistula and the diagnosis of tracheomalacia or associated respiratory anomalies. When a distal fistula is found, its occlusion with a Fogarty balloon catheter improves mechanical ventilation and facilitates surgical repair. This review provides a detailed overview on the use of TBS in newborns with EA, focusing on technical aspects, anesthesiological management, indications and limits. The benefits and risks of the procedure are also compared with alternative diagnostic tools, such as an esophageal contrast study, computed tomography scan and ultrasound.

Preoperative Tracheoscopy for Esophageal Atresia and/or Congenital Esoaerian Fistula: Experience at Cliniques Universitaires Saint Luc in Brussels

“…There are few data on the use of TBS as well as on the diagnostic evaluation and operative management of newborns with esophageal atresia [2]. The frequency of use in our series was 71.6%.…”

“…Preoperative tracheobroncoscopy (TBS) in the diagnostic evaluation of newborns with esophageal atresia was described in 1981 [1], more than 30 years ago. However, the value of this procedure is in fact much debated [2]. Only a few studies have clearly explored the benefits of tracheobronchoscopy.…”

“…Only a few studies have clearly explored the benefits of tracheobronchoscopy. This procedure is therefore not yet systematically included in the diagnostic and therapeutic evaluation in several pediatric surgery centers [2]. The role of routine preoperative TBS in esophageal atresia (EA) patients remains a matter of debate [2], with only 43% -60% of contemporary paediatric surgeons routinely using preoperative TBS in this setting [3] [4].…”

“…This procedure is therefore not yet systematically included in the diagnostic and therapeutic evaluation in several pediatric surgery centers [2]. The role of routine preoperative TBS in esophageal atresia (EA) patients remains a matter of debate [2], with only 43% -60% of contemporary paediatric surgeons routinely using preoperative TBS in this setting [3] [4]. Advocates cite preoperative TBS findings which may impact management in 21% -45% of EA patients, most notably unusual fistula position and tracheobronchial tree anomalies, and less commonly laryngeal clefts or subglottic stenosis [5] [6].…”

Endoscopic Detection and Surgical Repair of Congenital Tracheo-Esophageal-Fistula (TEF) ± Esophageal Atresia (EA)

“…In the latest review paper, Parolioni et al (2014) came to the conclusion that TrSc with a rigid tracheoscope "has proven most useful in the diagnostic and therapeutic assessment of newborns" with EA [27].…”