Endoscopic treatment of recurrent tracheo-oesophageal fistulae: long-term results

Abstract

Recurrent Tracheo-Oesophageal Fistula (Rtof) Occurs In 5%-15% Of Patients Following Oesophageal Atresia Repair. Re-Thoracotomy Is Technically Challenging And Associated With Significant Morbidity, Including A Re-Fistulation Rate Of 10%-22%. Endoscopic Occlusion Of The Rtof With Tissue Adhesives (Fibrin Glue, Histoacryl) Is Reported To Be Safe And Highly Effective. However, Long-Term Results Of Such Therapy Are Absent From The Literature. A Postal Survey Of 13 Institutions Reporting The Use Of Such Treatment Regimes For Rtof In The Literature Between 1974 And 1995 Was Performed, And Data Collected Concerning The Long-Term Outcomes Of Their Reported Patients. Eleven Institutions Responded To The Request For Data, Providing 22 Patients (Age Range 1 Month To 12 Years) For Review. All Had Undergone Initially Successful Rtof Closure By Endoscopic Methods And Had Been Followed Up For A Median Of 107 Months (Range 3-264 Months). There Was No Morbidity Or Mortality Directly Related To The Procedure. Overall, Only 55% Of These Endoscopically Treated Fistulas Remained Closed Long-Term. Fistula Recurrence Invariably Occurred Within 12 Months Of Successful Therapy (Median 46 Days, Range 9-335). Most Patients Required Multiple Endoscopic Procedures To Achieve Successful Rtof Closure (Median 2.0, Range 1-4 Attempts), Although Significantly Fewer Attempts Were Required With Fibrin Glue Therapy. Surgical Re-Exploration Remains The Treatment Of Choice In The Fit Child. Endoscopic Therapy Offers A Safe And Elegant Alternative To High-Risk Surgery In The Sick Child, Although Repeated Treatments May Be Required For Successful Rtof Closure.