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Tobia A, Luque CG, Leitmeyer K, Dorling M, Chadha NK. Endoscopic treatment in pediatric patients with recurrent and H-type tracheoesophageal fistulas - A systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol 2023; 168:111541. [PMID: 37043961 DOI: 10.1016/j.ijporl.2023.111541] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 03/28/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVES Endoscopic treatments for managing recurrent tracheoesophageal fistula (rTEF) and H-type TEF are being utilized lately; however, the preferred technique is yet to be determined. We aimed to systematically review existing publications on endoscopic treatment of rTEF and H-type TEF to analyze their success and complication rates. METHODS PRISMA guidelines were followed. MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials were comprehensively searched in accordance to a priori developed protocol, from 1975 until 2020. English, Spanish and German papers were included. Studies were independently screened and analyzed by two reviewers. RESULTS 84 full texts were assessed for eligibility out of 581 screened studies, of these, 39 studies with 127 patients were eligible for inclusion (115 rTEF and 12 H-type TEF). All included studies were cases reports or case series. Overall success rate was 45% with sealant injection, 87% with de-epithelialization and 80% with sealant injection and de-epithelialization combined. The mean number of required treatments for success was 1.9 (range 1-6). Mixed effect model meta-analysis of case series with n > 1 showed that sealant injection had a significantly lower success rate of 50% (95% CI 1-99%, I2 72%) compared to de-epithelialization 90% (95% CI 72-99%, I2 27%), p = 0.007 and the combination of both techniques 87% (95% CI 68-99%, I2 11%), p = 0.02. Nine patients (7%) had transient respiratory distress. No mortalities reported. CONCLUSION Endoscopic treatment for rTEF and H-type fistula is a minimally invasive technique with favorable outcome and considerably less morbidity compared to open surgery, suggesting it as a safe and effective first line treatment option. Repeated endoscopic treatment attempts can be expected to obtain complete closure. De-epithelization techniques with or without combined tissue adhesive injection had significantly better results than sealant injection techniques alone.
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Affiliation(s)
- Amjad Tobia
- Division of Pediatric Otolaryngology-Head & Neck Surgery, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Carolina Grau Luque
- Division of Pediatric Otolaryngology-Head & Neck Surgery, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Department of Otolaryngology, Head and Neck Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Katharina Leitmeyer
- Division of Pediatric Otolaryngology-Head & Neck Surgery, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Division of Pediatric Otolaryngology-Head & Neck Surgery, University Children's Hospital of Basel, Basel, Switzerland
| | - Marisa Dorling
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Neil K Chadha
- Division of Pediatric Otolaryngology-Head & Neck Surgery, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Ling Y, Sun B, Li J, Ma L, Li D, Yin G, Meng F, Gao M. Endoscopic interventional therapies for tracheoesophageal fistulas in children: A systematic review. Front Pediatr 2023; 11:1121803. [PMID: 36911034 PMCID: PMC9992425 DOI: 10.3389/fped.2023.1121803] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/01/2023] [Indexed: 02/24/2023] Open
Abstract
Methods An 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). Results Among 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). Conclusion Endoscopic 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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Affiliation(s)
- Yaozheng Ling
- Department of Pediatrics, The First Hospital of Jilin University, Changchun, China
| | - Bingyue Sun
- Department of Pediatrics, The First Hospital of Jilin University, Changchun, China
| | - Junhui Li
- Department of Pediatrics, The First Hospital of Jilin University, Changchun, China
| | - Li Ma
- Department of Pediatrics, The First Hospital of Jilin University, Changchun, China
| | - Deli Li
- Department of Pediatrics, The First Hospital of Jilin University, Changchun, China
| | - Guo Yin
- Medical Insurance Office, The First Hospital of Jilin University, Changchun, China
| | - Fanzheng Meng
- Department of Pediatrics, The First Hospital of Jilin University, Changchun, China.,Center for Pathogen Biology and Infectious Diseases, The First Hospital of Jilin University, Changchun, China
| | - Man Gao
- Department of Pediatrics, The First Hospital of Jilin University, Changchun, China.,Center for Pathogen Biology and Infectious Diseases, The First Hospital of Jilin University, Changchun, China
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van der Zee DC, van Herwaarden MYA, Hulsker CCC, Witvliet MJ, Tytgat SHA. Esophageal Atresia and Upper Airway Pathology. Clin Perinatol 2017; 44:753-762. [PMID: 29127957 DOI: 10.1016/j.clp.2017.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Esophageal atresia is an anomaly with frequently occurring sequelae requiring lifelong management and follow-up. Because of the complex issues that can be encountered, patients with esophageal atresia preferably should be managed in centers of expertise that have the ability to deal with all types of anomalies and sequelae and can perform rigorous lifelong follow-up. Tracheomalacia is an often-occurring concurrent anomaly that may cause acute life-threatening events and may warrant immediate management. In the past, major thoracotomies were necessary to carry out the aortopexy. Nowadays, aortopexy and posterior tracheopexy can both be performed thoracoscopically with quick recovery.
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Affiliation(s)
- David C van der Zee
- Department of Pediatric Surgery, University Medical Center Utrecht, KE. 04.140.5, PO Box 85090, Utrecht 3508 AB, The Netherlands.
| | - Maud Y A van Herwaarden
- Department of Pediatric Surgery, University Medical Center Utrecht, KE. 04.140.5, PO Box 85090, Utrecht 3508 AB, The Netherlands
| | - Caroline C C Hulsker
- Department of Pediatric Surgery, University Medical Center Utrecht, KE. 04.140.5, PO Box 85090, Utrecht 3508 AB, The Netherlands
| | - Marieke J Witvliet
- Department of Pediatric Surgery, University Medical Center Utrecht, KE. 04.140.5, PO Box 85090, Utrecht 3508 AB, The Netherlands
| | - Stefaan H A Tytgat
- Department of Pediatric Surgery, University Medical Center Utrecht, KE. 04.140.5, PO Box 85090, Utrecht 3508 AB, The Netherlands
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Gregory S, Chun RH, Parakininkas D, Amos L, Fons R, Lerner DG, Lal DR, Sulman C. Endoscopic esophageal and tracheal cauterization for closure of recurrent tracheoesophageal fistula: A case report and review of the literature. Int J Pediatr Otorhinolaryngol 2017; 98:158-161. [PMID: 28583493 DOI: 10.1016/j.ijporl.2017.04.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 04/27/2017] [Accepted: 04/30/2017] [Indexed: 10/19/2022]
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.
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Affiliation(s)
- Stacie Gregory
- Department of Otolaryngology, Medical College of Wisconsin (MCW), Milwaukee, WI, United States.
| | - Robert H Chun
- Department of Otolaryngology, Medical College of Wisconsin (MCW), Milwaukee, WI, United States.
| | - Daiva Parakininkas
- Department of Pediatrics, Division of Pulmonary Medicine, MCW, Milwaukee, WI, United States.
| | - Louella Amos
- Department of Pediatrics, Division of Pulmonary Medicine, MCW, Milwaukee, WI, United States.
| | - Roger Fons
- Department of Anesthesiology, MCW, Milwaukee, WI, United States.
| | - Diana G Lerner
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, MCW, Milwaukee, WI, United States.
| | - Dave R Lal
- Department of Surgery, Division of Pediatric Surgery, MCW, Milwaukee, WI, United States.
| | - Cecille Sulman
- Department of Otolaryngology, Medical College of Wisconsin (MCW), Milwaukee, WI, United States.
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Lepeytre C, Roquelaure B, de Lagausie P, Merrot T, Dubus JC. Reperméation de fistule œso-trachéale dans l’atrésie de l’œsophage de type III : un diagnostic et une prise en charge difficile. Arch Pediatr 2014; 21:716-21. [DOI: 10.1016/j.arcped.2014.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 03/07/2014] [Accepted: 04/04/2014] [Indexed: 11/29/2022]
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Oliveira C, Zamakhshary M, Alfadda T, Alhabshan F, Alshalaan H, Miller S, Kim PCW. An innovative method of pediatric chest wall reconstruction using Surgisis and swinging rib technique. J Pediatr Surg 2012; 47:867-73. [PMID: 22595563 DOI: 10.1016/j.jpedsurg.2012.01.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Accepted: 01/26/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE Herein, we describe a new surgical approach for chest wall reconstruction using a native supporting rib and Surgisis. METHODS A retrospective review of 3 cases from 2 tertiary pediatric health care centers presenting with chest wall defects in the neonatal period was performed. Perioperative data were collected. RESULTS Two chest wall deformities were diagnosed at birth (Poland syndrome and cleft sternum). One patient was diagnosed prenatally with a mediastinal mass. The first infant had absent ribs 2 through 9. He underwent chest wall reconstruction at 4 weeks of life because of difficulty weaning from ventilation related to paradoxical breathing. The hamartoma of the second asymptomatic patient was removed at 6 weeks. The third patient's V-shaped sternal defect encompassed through the upper two thirds of the sternum and was repaired at 6 months of age with intraoperative transesophageal echocardiogram monitoring. In all cases, Surgisis (collagen matrix) was used as an onlay patch. In 2 cases, a swinging rib acted supportive. Neither patient had intraoperative complications. CONCLUSION Surgisis is useful in pediatric chest wall reconstruction, particularly in combination with swinging ribs. The capacity for adaptation to the child's growth of this approach is crucial. Short-term safety is shown, but long-term assessment is required.
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Affiliation(s)
- Carol Oliveira
- The Hospital for Sick Children, Toronto, Ontario, Canada
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Altorjay Á, Mucs M, Rüll M, Tihanyi Z, Hamvas B, Madácsy L, Paál B. Recurrent, Nonmalignant Tracheoesophageal Fistulas and the Need for Surgical Improvisation. Ann Thorac Surg 2010; 89:1789-96. [DOI: 10.1016/j.athoracsur.2010.02.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Revised: 02/09/2010] [Accepted: 02/12/2010] [Indexed: 11/27/2022]
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Rothenberg SS. Experience with Thoracoscopic Tracheal Surgery in Infants and Children. J Laparoendosc Adv Surg Tech A 2009; 19:671-4. [DOI: 10.1089/lap.2009.0083] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Steven S. Rothenberg
- Department of Pediatric Surgery, The Rocky Mountain Hospital for Children, Denver, Colorado; Columbia University College of Physicians and Surgeons, New York, New York
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Hiles M, Nihsen E, Hodde J. Biologics in Fistula Surgery: Parallels with Chronic Wounds. SEMINARS IN COLON AND RECTAL SURGERY 2009. [DOI: 10.1053/j.scrs.2008.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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