Endoscopic treatment of tracheoesophageal fistula: use of stents and endoclips

Abstract

Abstract: Tracheoesophageal fistula (TEF) is a rare gastrointestinal pathology of abnormal connection or passage between the esophagus and the trachea. Most frequently, TEF is a primary (congenital) in origin and most often associated with the esophageal atresia (EA). TEF can develop as a consequence of another disease, syndrome or condition (secondary) such as infectious esophagitis, trauma, foreign body or neoplasm. Regardless of the etiology, TEF represents treatment challenge. TEF can present with wide ranging symptoms including cough, choking, gagging, poor growth and occasionally with severe complications of pulmonary aspiration. The diagnostic test of choice remains radiographic imaging. Contrast studies can usually identify majority of TEFs including their anatomical characteristics such as size, location and communication. Sometimes additional imaging in form of CT-scan or magnetic resonance imaging (MRI) or direct bronchoscopy/endoscopy need to perform to identify TEF with unusual anatomical characteristics. Surgical correction has been the mainstay of TEF repair, especially with an advent of endoscopic and robotic surgery. Surgical closure effectiveness and decreased adverse events have continued to advance over the past few decades. However, new endoscopic interventions including esophageal stenting and clipping have emerged as supplemental or alternative options. They are safe and effective, minimally invasive treatment options with usually few adverse events. The endoscopic treatment might also be preferred in certain patients who cannot undergo surgery safely. Although, much more common in adult population, esophageal stenting or clipping is becoming more popular in pediatrics.