Tracheoesophageal Fistula Follow-up
- Author: Sat Sharma, MD, FRCPC; Chief Editor: Julian Katz, MD more...
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.
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.
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.
In children operated for esophageal atresia (EA) and/or TEFs, follow-up deglutitive and respiratory symptoms may occur and should be evaluated with videofluoroscopy.
Vocal cord paresis/paralysis may occur more often in in patients treated for esophageal atresia (EA) with and without fistula with thorascopic repair compared with open repair. This be due thoracoscopic dissection of the esophagus high into the thoracic inlet.
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%.
For excellent patient education resources, see eMedicineHealth's patient education article Bronchoscopy.
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|Anatomic Characteristics||Percent of Cases|
|Esophageal atresia with distal TEF||87|
|Isolated esophageal atresia without TEF||8|
|Esophageal atresia with proximal TEF||1|
|Esophageal atresia with proximal and distal TEF||1|