Tracheoesophageal fistula without esophageal atresia: are pull-back tube esophagograms needed for diagnosis?

Abstract

We believe that CS should be the examination of choice in most patients suspected of having a tracheoesophageal fistula without esophageal atresia. A PBTE is indicated in patients who are intubated or are at significant risk of aspiration. Furthermore, a PBTE is also indicated where contrast material is seen in the airway on CS and there is uncertainty whether this is due to aspiration or a fistula.

Respiratory Care of Infants and Children with Congenital Tracheo-Oesophageal Fistula and Oesophageal Atresia

“…Traditionally, an oesophagram with a pull-back technique in which the lower oesophagus is filled and the catheter pulled upward has been used, but a simpler contrast swallow may also be diagnostic. 41 If an isolated TOF is not seen through fluoroscopic examination and clinical suspicion remains, bronchoscopy should be performed under anaesthesia, as this sometimes identifies a fistula tract that was not seen with fluoroscopy. Methylene blue placed in the trachea combined with bronchoscopy and oesophageal endoscopy has also been used to determine the presence and location of a tracheo-oesophageal fistula.…”

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

“…In the presence of isolated TEF without EA, the anatomy allows for successful radiological visualization of the membranous trachea. The fistula runs in an oblique direction upward from its origin in the esophagus; due to its anatomy, this type of fistula is more precisely described as an "N-type fistula" [21]. In one of our cases, PBF was performed successfully prior to admission to our department.…”

Imaging of Large Airways Disorders

“…Radiographic contrast studies of the esophagus may show a TEF [19], but at times CT may be required for this purpose [20,21].…”