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Advances in Neonatal Care : Official... Feb 2018Tracheoesophageal fistula (TEF) and esophageal atresia (EA) are rare anomalies in neonates. Up to 50% of neonates with TEF/EA will have Vertebral anomalies (V), Anal... (Review)
Review
BACKGROUND
Tracheoesophageal fistula (TEF) and esophageal atresia (EA) are rare anomalies in neonates. Up to 50% of neonates with TEF/EA will have Vertebral anomalies (V), Anal atresia (A), Cardiac anomalies (C), Tracheoesophageal fistula (T), Esophageal atresia (E), Renal anomalies (R), and Limb anomalies (L) (VACTERL) association, which has the potential to cause serious morbidity.
PURPOSE
Timely management of the neonate can greatly impact the infant's overall outcome. Spreading latest evidence-based knowledge and sharing practical experience with clinicians across various levels of the neonatal intensive care unit and well-baby units have the potential to decrease the rate of morbidity and mortality.
METHODS/SEARCH STRATEGY
PubMed, CINAHL, Cochrane Review, and Google Scholar were used to search key words- tracheoesophageal fistula, esophageal atresia, TEF/EA, VACTERL, long gap, post-operative management, NICU, pediatric surgery-for articles that were relevant and current.
FINDINGS/RESULTS
Advancements in both technology and medicine have helped identify and decrease postsurgical complications. More understanding and clarity are needed to manage acid suppression and its effects in a timely way.
IMPLICATIONS FOR PRACTICE
Knowing the clinical signs of potential TEF/EA, clinicians can initiate preoperative management and expedite transfer to a hospital with pediatric surgeons who are experts in TEF/EA management to prevent long-term morbidity.
IMPLICATIONS FOR RESEARCH
Various methods of perioperative management exist, and future studies should look into standardizing perioperative care. Other areas of research should include acid suppression recommendation, reducing long-term morbidity seen in patients with TEF/EA, postoperative complications, and how we can safely and effectively decrease the length of time to surgery for long-gap atresia in neonates.
Topics: Disease Management; Early Diagnosis; Esophageal Atresia; Humans; Infant, Newborn; Tracheoesophageal Fistula
PubMed: 29373345
DOI: 10.1097/ANC.0000000000000464 -
JAAPA : Official Journal of the... Jun 2022Esophageal atresia and tracheoesophageal fistula are often-concomitant pathologies that primarily afflict neonates. The complications of these anomalies may lead to... (Review)
Review
Esophageal atresia and tracheoesophageal fistula are often-concomitant pathologies that primarily afflict neonates. The complications of these anomalies may lead to increased morbidity and mortality, and clinicians should be familiar with the diagnosis and management of these pathologies. Clinicians can improve patient outcomes by having a thorough understanding of the signs and symptoms, classification systems, diagnostic workup, and surgical intervention options for these patients. Early recognition and treatment are imperative in providing patients with the best opportunity for recovery.
Topics: Esophageal Atresia; Humans; Infant, Newborn; Tracheoesophageal Fistula
PubMed: 35617475
DOI: 10.1097/01.JAA.0000830180.79745.b9 -
Chest Surgery Clinics of North America May 2003Acquired TEF is a rare complication that can occur from a variety of causes. The most common etiology of nonmalignant TEF is as a complication of intubation with... (Review)
Review
Acquired TEF is a rare complication that can occur from a variety of causes. The most common etiology of nonmalignant TEF is as a complication of intubation with cuff-related tracheal injury. Most patients present with increased secretions, pneumonia, and evidence of aspiration of gastric contents while the patient is on mechanical ventilation. When diagnosed after extubation, the most frequent sign of TEF is coughing after swallowing. A high index of suspicion is required in patients at risk for developing a TEF. The diagnostic evaluation is by bronchoscopy and esophagoscopy. When the diagnosis has been made, the immediate goal should be to minimize tracheobronchial soilage by placing the cuff of a tracheostomy tube distal to the fistula. Reflux of gastric contents is diminished by placement of a gastrostomy tube, and adequate nutrition is facilitated by inserting a jejunostomy tube. Surgical correction is required because spontaneous closure is rare, but surgery should be postponed until the patient is weaned from mechanical ventilation because positive pressure ventilation after tracheal repair carries an increased risk of anastomotic dehiscence and restenosis. An anterior cervical collar incision can be used for most cases of post-intubation TEFs. The esophagus should be closed in two layers over a nasogastric tube and buttressed with a pedicled strap muscle flap. If the tracheal defect is small, primary repair can be employed. In most cases, however, the best results can be achieved with tracheal resection and reconstruction. The patient should be extubated at the completion of the case, if possible. With this strategy, as first described by Grillo and colleagues [27], single-stage repair can be performed safely and with a high success rate. Malignant TEFs cannot be cured because of the underlying incurable disease process. As with nonmalignant TEFs, the principal complications are tracheo-bronchial contamination and poor nutrition. Without prompt palliation, death occurs rapidly, with a mean survival time of between 1 and 6 weeks in patients who are treated with supportive care alone. The most common primary tumor causing malignant TEF is esophageal carcinoma. The other frequent cause is lung cancer. Patients present with signs and symptoms typical of TEF, including coughing after swallowing. Diagnosis is made by barium esophagography, and the location and size of the fistula is determined by bronchoscopy and esophagoscopy. Treatment must correct the two problems of airway contamination and poor nutrition. The most effective treatments are esophageal bypass and esophageal stenting. Bypass is demonstrated to resolve respiratory soilage and allow fairly normal swallowing, but it should be reserved for patients who can tolerate a major operation. Stenting can be offered to nearly all patients regardless of their physiologic condition. Stenting also limits aspiration and allows swallowing. Esophageal exclusion is rarely indicated in the current era of familiarity with stenting techniques. Direct fistula closure and fistula resection do not yield satisfactory results. Radiation therapy and chemotherapy combined might offer a survival benefit compared with supportive care alone. The complication of TEF secondary to malignancy is a devastating problem that carries a bleak prognosis, but when it is performed promptly after the diagnosis of a malignant TEF, esophageal bypass or stenting improves survival and quality of life for these unfortunate patients.
Topics: Digestive System Surgical Procedures; Humans; Otorhinolaryngologic Surgical Procedures; Tracheoesophageal Fistula; Treatment Outcome
PubMed: 12755313
DOI: 10.1016/s1052-3359(03)00030-9 -
The Surgical Clinics of North America Oct 2022Esophageal atresia (EA) with tracheoesophageal fistula (TEF) is among the most common congenital anomalies requiring surgical intervention in infancy. General surgeons... (Review)
Review
Esophageal atresia (EA) with tracheoesophageal fistula (TEF) is among the most common congenital anomalies requiring surgical intervention in infancy. General surgeons practicing in rural or austere environments may encounter emergency situations requiring their involvement. Respiratory emergencies can arise in the neonatal period; the recommended approaches are the ligation of the fistula through the chest or occlusion of the distal esophagus through the abdomen. As survivors of the condition reach late adulthood, general surgeons can anticipate encountering these patients. An understanding of risk factors, common symptoms, associated anomalies, and the appropriate diagnostic evaluation will facilitate care.
Topics: Adult; Esophageal Atresia; Humans; Infant, Newborn; Surgeons; Tracheoesophageal Fistula; Treatment Outcome
PubMed: 36209744
DOI: 10.1016/j.suc.2022.07.008 -
Current Opinion in Otolaryngology &... Dec 2016The management of primary or recurrent tracheoesophageal fistula (TEF) remains an important challenge for airway surgeons. (Review)
Review
PURPOSE OF REVIEW
The management of primary or recurrent tracheoesophageal fistula (TEF) remains an important challenge for airway surgeons.
RECENT FINDINGS
The accuracy of prenatal detection can be significantly improved in specialized centers. Routine preoperative and postoperative airway endoscopy is recommended to detect a proximal fistula and evaluate vocal cord motility. Minimally invasive thoracoscopic approaches have equal success and improved cosmesis and visualization as compared with thoracostomy. Novel open approaches for complex TEF include a transcervical, transtracheal approach, and slide tracheoplasty.Endoscopic closure of TEF carries less morbidity. Options include de-epithelialization of the tract, interposed material, and combinations. The mean operative time is 30 min; however multiple treatments are required (average 2.1). Use of continuous positive airway pressure in the immediate postoperative period was not associated with increased leak or recurrence. Children post-TEF repair continue to have frequent gastrointestinal and respiratory symptoms.
SUMMARY
Prenatal diagnosis is beneficial both for prenatal counseling and for planning care. The ideal endoscopic approach is undecided but remains an interesting alternative to open surgery provided failures are anticipated and prompt repeated treatments initiated to preclude ongoing respiratory complications. Transtracheal approaches and slide tracheoplasty are well tolerated and effective in complex/recurrent cases. Long-term follow-up of patients with TEF is important.
Topics: Endoscopy; Humans; Postoperative Complications; Preoperative Care; Recurrence; Tracheoesophageal Fistula
PubMed: 27653493
DOI: 10.1097/MOO.0000000000000315 -
European Review For Medical and... Oct 2022
Topics: Humans; Tracheoesophageal Fistula
PubMed: 36263567
DOI: 10.26355/eurrev_202210_29868 -
Thoracic Surgery Clinics Feb 2014This article addresses the treatment of malignant enterorespiratory fistulas, especially malignant tracheoesophageal fistula (mTEF). mTEF typically occurs after... (Review)
Review
This article addresses the treatment of malignant enterorespiratory fistulas, especially malignant tracheoesophageal fistula (mTEF). mTEF typically occurs after radiochemotherapy for advanced esophageal cancer. Life expectancy is measured in months after successful treatment, and in days to weeks with a persistent fistula. To stop repeated episodes of aspiration and septic pneumonia, single or double stenting of the esophagus and trachea with self-expandable coated stents is the established palliative treatment. The indications, techniques, and pitfalls of esophageal and tracheal stenting are described. Surgical interventions are justified only in very select cases, so this article focuses on interventional rather than surgical treatment.
Topics: Bronchoscopy; Esophagoscopy; Esophagus; Humans; Palliative Care; Radiography, Interventional; Stents; Trachea; Tracheoesophageal Fistula
PubMed: 24295667
DOI: 10.1016/j.thorsurg.2013.09.006 -
European Respiratory Review : An... Dec 2020Tracheo-oesophageal fistula (TOF) is a pathological connection between the trachea and the oesophagus that is associated with various underlying conditions including... (Review)
Review
Tracheo-oesophageal fistula (TOF) is a pathological connection between the trachea and the oesophagus that is associated with various underlying conditions including malignancies, infections, inhalation injuries and traumatic damage. As the condition spans multiple organ systems with varying aetiologies and acuities, TOF poses unique diagnostic and management challenges to pulmonologists, gastroenterologists and thoracic surgeons alike. Although stents have been a cornerstone in the management of TOF, there exists a large gap in our understanding of their efficacy and precise methodology, making stenting procedure both art and science. TOFs relating to underlying oesophageal or tracheal malignancies require advanced understanding of the airway and digestive tract anatomy, dimensions of the fistula, stent characteristics and types, and the interplay between the oesophageal stent and the airway stent if dual stenting procedure is elected. In this review article, we review the most up-to-date data on risk factors, clinical manifestations, diagnostic approaches, management methods and prognosis. Consequently, this article serves to evaluate current therapeutic strategies and the future directions in the areas of 3D-printed stents, over-the-scope clipping systems, tissue matrices and atrial septal closure devices.
Topics: Adult; Humans; Prognosis; Stents; Trachea; Tracheoesophageal Fistula
PubMed: 33153989
DOI: 10.1183/16000617.0094-2020 -
The Journal of the Association of... Apr 2009
Topics: Accidents, Traffic; Humans; Intubation, Gastrointestinal; Magnetic Resonance Imaging; Male; Risk Factors; Tracheoesophageal Fistula; Young Adult
PubMed: 19702037
DOI: No ID Found -
Asian Journal of Surgery Sep 2021
Review
Topics: Humans; Tracheoesophageal Fistula; Tracheostomy; Tracheotomy
PubMed: 34246537
DOI: 10.1016/j.asjsur.2021.06.014