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Roy CF, Maltezeanu A, Laberge JM, Kaspy K, Sant'Anna A, Broucqsault H, Fayoux P, Daniel SJ. Endoscopic repair of tracheoesophageal fistulas: A contemporary multi-institutional case series and literature review. Int J Pediatr Otorhinolaryngol 2024; 181:111960. [PMID: 38728974 DOI: 10.1016/j.ijporl.2024.111960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 04/16/2024] [Accepted: 04/21/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVES Recurrent and primary tracheoesophageal fistulas (TEFs) are a challenging surgical pathology to treat, as standard open surgical approaches are associated with high morbidity and mortality. As such, endoscopic modalities have gained interest as an alluring alternative, yet variable success rates have been reported in the literature. The aim of this study was to provide a contemporary update of the literature and describe our institutional experience with the bronchoscopic obliteration of recurrent and primary TEFs. METHODS Retrospective chart review of all pediatric patients having undergone endoscopic TEF repair at two pediatric academic centers in Montreal, Canada and Lille, France between January 1, 2008 to December 31, 2020. RESULTS 28 patients with TEFs (20 recurrent, 8 primary) underwent a total of 48 endoscopic procedures. TEF repair was performed under endoscopic guidance using various combinations of techniques, including fistula de-epithelialization (endoscopic brush, thulium laser, trichloroacetic acid-soaked pledgets or electrocautery), tissue adhesives, submucosal augmentation, esophageal clip and stenting. Successful closure was achieved in 16 patients (57 %), while 12 (43 %) required eventual open or thoracoscopic repair. The mean number of endoscopic procedures was 1.7. There were no major treatment-related complications such as pneumothorax, mediastinitis or death (mean follow-up 50.8 months). CONCLUSIONS Endoscopic repair of recurrent or primary TEFs is a valuable component of our therapeutic armamentarium and may contribute to decreased surgical morbidity in this complex patient population. Families should be counselled that endoscopic results may be more modest than with open or thoracoscopic approaches, and multiple procedures may be required.
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Affiliation(s)
- Catherine F Roy
- Department of Pediatric Otolaryngology, Montreal Children's Hospital, McGill University Health Centre, 1001 Decarie, H4A 3J1, Montreal, Quebec, Canada.
| | - Alix Maltezeanu
- Department of Pediatric Otolaryngology - Head and Neck Surgery, CHU Lille, F-59000, Lille, France.
| | - Jean-Martin Laberge
- Department of Pediatric Surgery, Montreal Children's Hospital, McGill University Health Centre, 1001 Decarie, H4A 3J1, Montreal, Quebec, Canada.
| | - Kimberley Kaspy
- Department of Pediatrics, Division of Respiratory Medicine, Montreal Children's Hospital, McGill University Health Centre, 1001 Decarie, H4A 3J1, Montreal, Quebec, Canada.
| | - Ana Sant'Anna
- Department of Pediatrics, Division of Gastroenterology and Nutrition, Montreal Children's Hospital, McGill University Health Centre, 1001 Decarie, H4A 3J1, Montreal, Quebec, Canada.
| | - Hélène Broucqsault
- Department of Pediatric Otolaryngology - Head and Neck Surgery, CHU Lille, F-59000, Lille, France.
| | - Pierre Fayoux
- Department of Pediatric Otolaryngology - Head and Neck Surgery, CHU Lille, F-59000, Lille, France.
| | - Sam J Daniel
- Department of Pediatric Otolaryngology, Montreal Children's Hospital, McGill University Health Centre, 1001 Decarie, H4A 3J1, Montreal, Quebec, Canada.
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Morchio C, Ganarin A, Conforti A, Leva E, Gaglione G, Brenco G, Zambaiti E, Chiarenza SF, Caldaro T, Cheli M, Boroni G, Marcandella ES, Riccipetitoni G, Cacciaguerra S, Di Benedetto V, Gentilino V, Lisi G, Morini F, Midrio P. Diagnosis and Management of Congenital H-Type Tracheoesophageal Fistula: Results of a National Survey. Children (Basel) 2024; 11:423. [PMID: 38671640 PMCID: PMC11048938 DOI: 10.3390/children11040423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/12/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Congenital h-type tracheoesophageal fistula (H-TEF) without esophageal atresia (EA) represents about 4% of congenital esophageal anomalies. The diagnosis is challenging, and surgery is considered curative. The aim was to report a national survey on the diagnosis, management, and outcome of patients with congenital H-TEF. METHODS Following approval of the Italian Society of Pediatric Surgery, a survey was sent to all Pediatric Surgery Units to retrospectively collect H-TEF treated in the period 2010-2022. Descriptive analysis was performed, and results are given as prevalence, mean ± standard deviation (SD), or median and interquartile range (IQR). RESULTS The survey was sent to 65 units. Seventeen responded with one or more cases; 78 patients were diagnosed with H-TEF during the study period. Associated malformations were present in 43%, mostly cardiac (31%). The most frequent symptoms were cough (36%), bronchopneumonia (24%), and dysphagia (19%). H-TEF was detected by tracheobronchoscopy (90%), and/or upper GI (58%), and/or esophagoscopy (32%). The median age at diagnosis was 23 days (1 day-18 years). The most common approach was cervicotomy (76%), followed by thoracoscopy (14%) and thoracotomy (9%). The fistula underwent ligation and section of the fistula in 90% of the patients and clip closure and section in 9%. In one patient, the fistula was cauterized endoscopically. H-TEF preoperative cannulation was performed in 68% of cases, and a drain was placed in 26%. One month after surgery, 13% of the patients had mild persisting symptoms, mainly hypophonia. Recurrence occurred in 5%, and a second recurrence occurred in 1%. CONCLUSIONS H-TEF prevalence was six cases/year, consistent with the expected rate of five cases/year in our country. The diagnosis was challenging, sometimes delayed, and, in most patients, required multiple examinations. Fistula ligation and section through cervicotomy were the most frequent treatment. Long-term outcomes are good, and recurrence is a rare event.
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Affiliation(s)
- Cecilia Morchio
- School of Pediatric Surgery, University of Florence, 50100 Florence, Italy;
| | - Alba Ganarin
- Pediatric Surgery Unit, Ca’ Foncello Hospital, 31100 Treviso, Italy;
| | - Andrea Conforti
- Neonatal Surgery Unit, Medical and Surgical Department of Fetus-Newborn-Infant, Bambino Gesù Children’s Hospital, IRCCS, 00100 Rome, Italy;
| | - Ernesto Leva
- Pediatric Surgery Unit, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, University of Milan, 20100 Milan, Italy;
| | - Giovanni Gaglione
- UOC Pediatric Surgery Unit, AORN Santobono-Pausilipon, 80100 Naples, Italy;
| | - Gaia Brenco
- Pediatric Surgery Unit, IRCCS Giannina Gaslini’s Hospital, 16100 Genova, Italy;
| | - Elisa Zambaiti
- Department of Pediatric General Surgery, Regina Margherita Children’s Hospital, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, 10100 Turin, Italy;
| | | | - Tamara Caldaro
- Digestive Endoscopy and Surgery Unit, Bambino Gesu Children’s Hospital, IRCCS, 00100 Rome, Italy;
| | - Maurizio Cheli
- Pediatric Surgery Unit, Ospedale Papa Giovanni XXIII, 24100 Bergamo, Italy;
| | - Giovanni Boroni
- Department of Paediatric Surgery, ASST Spedali Civili di Brescia, 25100 Brescia, Italy;
| | - Elena Sofia Marcandella
- Paediatric Surgery Unit, Women’s and Children’s Health Department, University of Padua, 35100 Padua, Italy;
| | - Giovanna Riccipetitoni
- Department of Paediatric Surgery, “V. Buzzi” Children’s Hospital, 20100 Milan, Italy;
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | | | - Vincenzo Di Benedetto
- Department of Pediatric Surgery, G. Rodolico—San Marco Hospital, 95100 Catania, Italy;
| | - Valerio Gentilino
- Division of Pediatric Surgery, Woman and Child Department, “Filippo Del Ponte” Hospital, ASST Sette Laghi, 21100 Varese, Italy;
| | - Gabriele Lisi
- Pediatric Surgery Unit, Santo Spirito Hospital, University of Chieti-Pescara, 65100 Pescara, Italy;
| | - Francesco Morini
- Department of Maternal and Child Health and Urological Sciences, La Sapienza University, 00100 Rome, Italy;
| | - Paola Midrio
- Pediatric Surgery Unit, Ca’ Foncello Hospital, 31100 Treviso, Italy;
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Holmquist A, Wendt M, Papatziamos G, Svensson J, Wester T, Burgos CM, Gahm C. Endoscopic Chemocauterization with Trichloroacetic Acid for Congenital or Recurrent Tracheoesophageal Fistula in Children with Esophageal Atresia: Experience from a Tertiary Center. J Pediatr Surg 2024; 59:678-683. [PMID: 37978000 DOI: 10.1016/j.jpedsurg.2023.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Recurrent tracheoesophageal fistula (rTEF) is a well-known complication after surgery of EA, occurring in roughly 3-10% of the patients. Recent studies have highlighted safety and efficacy of endoscopic management of recurrent TEF. The aim of this study was to evaluate the efficacy of chemocauterization with trichloroacetic acid (TCA) in rTEF and congenital tracheoesophageal fistula (cTEF). METHODS Retrospective chart review of consecutive patients with recurrent or congenital TEF who underwent endoscopic chemo-cauterization between 2018 and 2022 at a tertiary center. Children diagnosed with TEF who underwent primary or secondary endoscopic treatment were included. Median follow up time was 19 months for rTEF and 33 months for cTEF. RESULTS During the study period, 18 patients were treated endoscopically by chemocatuerization with TCA at our institution. Treatment of recurrent TEF was successful in 13 of 14 patients (93%) Treatment of congenital TEF was successful in 2 of 4 patients (50%). In 14 patients, closure was seen after 1-2 treatments. There were no serious adverse reactions or complications to the endoscopic treatment of TEF. CONCLUSION Endoscopic chemocauterization is a minimal invasive technique with low morbidity and high success rate and may be considered as primary treatment for recurrent TEF. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Anders Holmquist
- Department for Women´s and Children´s Health, Karolinska Institutet, Stockholm, Sweden.
| | - Malin Wendt
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
| | - Georgios Papatziamos
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Jan Svensson
- Department for Women´s and Children´s Health, Karolinska Institutet, Stockholm, Sweden; Department of Pediatric Surgery, Astrid Lindgrens Childrens Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Tomas Wester
- Department for Women´s and Children´s Health, Karolinska Institutet, Stockholm, Sweden; Department of Pediatric Surgery, Astrid Lindgrens Childrens Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Carmen Mesas Burgos
- Department for Women´s and Children´s Health, Karolinska Institutet, Stockholm, Sweden; Department of Pediatric Surgery, Astrid Lindgrens Childrens Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Caroline Gahm
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Head Neck, Lung and Skin Cancer, Karolinska University Hospital, Stockholm, Sweden
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