Stacie Gregory1, Robert H Chun2, Daiva Parakininkas3, Louella Amos4, Roger Fons5, Diana G Lerner6, Dave R Lal7, Cecille Sulman8. 1. Department of Otolaryngology, Medical College of Wisconsin (MCW), Milwaukee, WI, United States. Electronic address: srgregory@siumed.edu. 2. Department of Otolaryngology, Medical College of Wisconsin (MCW), Milwaukee, WI, United States. Electronic address: rchun@mcw.edu. 3. Department of Pediatrics, Division of Pulmonary Medicine, MCW, Milwaukee, WI, United States. Electronic address: dparakin@mcw.edu. 4. Department of Pediatrics, Division of Pulmonary Medicine, MCW, Milwaukee, WI, United States. Electronic address: lamos@mcw.edu. 5. Department of Anesthesiology, MCW, Milwaukee, WI, United States. Electronic address: rfons@mcw.edu. 6. Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, MCW, Milwaukee, WI, United States. Electronic address: dglerner@mcw.edu. 7. Department of Surgery, Division of Pediatric Surgery, MCW, Milwaukee, WI, United States. Electronic address: dlal@mcw.edu. 8. Department of Otolaryngology, Medical College of Wisconsin (MCW), Milwaukee, WI, United States. Electronic address: csulman@mcw.edu.
Abstract
OBJECTIVE: Recurrent tracheoesophageal fistula (TEF) can be a diagnostic and therapeutic challenge. Traditional treatment is thoracotomy, which carries significant morbidity and technical difficulty especially in a previously operated field. Recently, endoscopic techniques have been advocated as a primary approach for treatment of recurrent TEF prior to open repair. This case report describes the endoscopic technique used to address a recurrent TEF. The existing literature of all reported endoscopic cauterization methods is reviewed. METHODS: An 8 month old with proximal esophageal atresia and distal TEF underwent endoscopic closure of a recurrent TEF. The fistula was approached endotracheally utilizing Bugbee electrocautery (EC) and endoluminally through the esophagus using argon plasma coagulator and placement of porcine submucosa graft into the tract. Current literature review is presented with a synthesis of data on cases utilizing endoscopically applied EC and the combined results of this closure technique. RESULTS: Our patient has maintained successful closure after a single treatment confirmed on follow up endoscopy 6 months post repair. Including this patient, there have been 30 patients with recurrent TEF treated utilizing endoscopic EC reported in the literature. The overall success rate is 78.8% with a mean of 1.88 procedures per successful closure. Comparing EC alone to EC combined with tissue glues or laser, success rates are 67% and 86% respectively. CONCLUSION: Endoscopic repair of recurrent TEF has proven to be safe and effective in the literature as an alternative to a second thoracotomy/open surgical repair. EC combined with tissue glues or laser is more effective than EC alone based on available data.
OBJECTIVE: Recurrent tracheoesophageal fistula (TEF) can be a diagnostic and therapeutic challenge. Traditional treatment is thoracotomy, which carries significant morbidity and technical difficulty especially in a previously operated field. Recently, endoscopic techniques have been advocated as a primary approach for treatment of recurrent TEF prior to open repair. This case report describes the endoscopic technique used to address a recurrent TEF. The existing literature of all reported endoscopic cauterization methods is reviewed. METHODS: An 8 month old with proximal esophageal atresia and distal TEF underwent endoscopic closure of a recurrent TEF. The fistula was approached endotracheally utilizing Bugbee electrocautery (EC) and endoluminally through the esophagus using argon plasma coagulator and placement of porcine submucosa graft into the tract. Current literature review is presented with a synthesis of data on cases utilizing endoscopically applied EC and the combined results of this closure technique. RESULTS: Our patient has maintained successful closure after a single treatment confirmed on follow up endoscopy 6 months post repair. Including this patient, there have been 30 patients with recurrent TEF treated utilizing endoscopic EC reported in the literature. The overall success rate is 78.8% with a mean of 1.88 procedures per successful closure. Comparing EC alone to EC combined with tissue glues or laser, success rates are 67% and 86% respectively. CONCLUSION: Endoscopic repair of recurrent TEF has proven to be safe and effective in the literature as an alternative to a second thoracotomy/open surgical repair. EC combined with tissue glues or laser is more effective than EC alone based on available data.