eMedicine Specialties > Gastroenterology > Esophagus

Tracheoesophageal Fistula: Follow-up

Author: Sat Sharma, MD, FRCPC, Professor and Head, Division of Pulmonary Medicine, Department of Internal Medicine, University of Manitoba; Site Director, Respiratory Medicine, St. Boniface General Hospital
Coauthor(s): Donald Duerksen, MD, Assistant Professor, Department of Medicine, Section of Gastroenterology, University of Manitoba, Canada
Contributor Information and Disclosures

Updated: Jun 16, 2006

Follow-up

Transfer

  • Transfer infants and children with TEF to a pediatric center experienced with surgical repair of TEF. The center should be experienced with providing support of critically ill pediatric patients.
  • Adults who develop acquired TEF must be transferred to a facility with thoracic surgery support and other adequate support services.

Deterrence/Prevention

  • Patients on prolonged ventilatory support are at risk of developing a TEF. The incidence of TEFs has decreased markedly following the introduction of endotracheal tube cuffs of high volume and low pressure. In critically ill patients, cuff pressure of 30-40 mm Hg may decrease capillary perfusion and result in tissue ischemia. Cuff pressures should be maintained below 25 mm Hg, even at the expense of a small leak. Optimal nutrition and use of flexible, small-caliber nasogastric feeding tubes may be of further help.

Complications

  • Congenital and acquired TEFs are associated with multiple complications, including recurrent pneumonia, acute lung injury, acute respiratory distress syndrome, lung abscess, poor nutrition, bronchiectasis from recurrent aspiration, respiratory failure, and death.
  • In patients with esophageal atresia and a TEF, abnormal esophageal motility is always present because of abnormal development and innervation of esophagus. Long-term follow-up studies have reported complications of esophagitis, Barrett esophagus, and hiatal hernia.
  • The major postoperative complications are tracheal stenosis and recurrent fistula. Tracheal stenosis occurs in patients who have extensive injury to the posterior tracheal wall. Surgical repair of tracheal stenosis may be performed at a later date. Recurrent fistulas develop in patients who require continued postoperative intubation. This generally occurs from breakdown of the repair, and the risk of infection spreading into the soft tissue planes, neck, and mediastinum is high.
  • Gastroesophageal reflux disease may later occur in half of patients who had repair for esophageal atresia and TEFs during the neonatal period. Treatment for reflux is antisecretory therapy. Rare complications of reflux are Barrett esophagus and esophageal carcinoma.

Prognosis

  • The survival rate in healthy infants who undergo surgical repair for a congenital TEF may be 100%. In groups of infants who have comorbidities or who are not fit enough for early repair, the survival rate is 80-95%. In a series of 118 patients, overall survival was more than 90% (Holder, 1987).

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • TEFs may recur at the site of surgical correction. Stricture at the site of anastomosis is common and may require subsequent esophageal dilation.
  • Acquired TEFs must be prevented in critically ill patients by keeping endotracheal cuff pressures less than 25 mm Hg.
  • Patients require early definitive surgery. If surgery is not feasible, actions must be taken to prevent aspiration. In a critically ill patient, esophageal ligation may be required until the patient becomes stable enough for surgical repair.
 


More on Tracheoesophageal Fistula

Overview: Tracheoesophageal Fistula
Differential Diagnoses & Workup: Tracheoesophageal Fistula
Treatment & Medication: Tracheoesophageal Fistula
Follow-up: Tracheoesophageal Fistula
Multimedia: Tracheoesophageal Fistula
References
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References

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Further Reading

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Keywords

TEF, fistulae, esophageal atresia, Down syndrome, duodenal atresia, cardiovascular defects, cardiac anomalies, ventricular septal defect, patent ductus arteriosus, tetralogy of Fallot, atrial septal defect, right-sided aortic arch, genitourinary anomalies, renal agenesis, renal dysphagia, horseshoe kidney, polycystic kidney, ureteral malformation, urethral malformation, hypospadia, gastrointestinal anomalies, imperforate anus, duodenal atresia, malrotation, intestinal malformation, Meckel diverticulum, annular pancreas, musculoskeletal anomalies, hemivertebrae, radial dysphagia, radial amelia, polydactyly, syndactyly, rib malformation, scoliosis, lower limb defect, tracheomalacia, esophageal dysmotility, gastroesophageal reflux, pharyngeal pseudodiverticulum, Zenker diverticulum, esophagoscopy

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Contributor Information and Disclosures

Author

Sat Sharma, MD, FRCPC, Professor and Head, Division of Pulmonary Medicine, Department of Internal Medicine, University of Manitoba; Site Director, Respiratory Medicine, St. Boniface General Hospital
Sat Sharma, MD, FRCPC is a member of the following medical societies: American Academy of Sleep Medicine, American College of Chest Physicians, American College of Physicians-American Society of Internal Medicine, American Thoracic Society, Canadian Medical Association, Royal College of Physicians and Surgeons of Canada, Royal Society of Medicine, Society of Critical Care Medicine, and World Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Donald Duerksen, MD, Assistant Professor, Department of Medicine, Section of Gastroenterology, University of Manitoba, Canada
Donald Duerksen, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, and American Society for Parenteral and Enteral Nutrition
Disclosure: Nothing to disclose.

Medical Editor

Marco Patti, MD, Director, Center for the Study of Gastrointestinal Motility and Secretion, Moffitt-Long Hospital; Associate Professor, Department of Surgery, University of California at San Francisco
Marco Patti, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Surgeons, American Gastroenterological Association, American Medical Association, American Surgical Association, Association for Academic Surgery, Pan-Pacific Surgical Association, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, Southwestern Surgical Congress, and Western Surgical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Noel Williams, MD, Professor Emeritus, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Professor, Department of Internal Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
Noel Williams, MD is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Assistant Dean for Medical Curriculum, Associate Professor of Medicine, Division of General Internal Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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