TOPLINE

Endoscopic chemocauterization using trichloroacetic acid appeared to be effective for closure of recurrent tracheoesophageal fistula (RTEF) in children. Only one patient in the large-sized RTEF group experienced a complication — aspiration pneumonia — following the initial procedure.

METHODOLOGY

• Researchers conducted a retrospective cohort study of all pediatric patients who underwent endoscopic treatment for TEF at a single pediatric tertiary center in Brussels, Belgium, from 2016 to 2023.
• A total of 14 patients were included: 13 with RTEF following surgical repair of esophageal atresia (EA-TEF) and one with isolated congenital TEF.
• The endoscopic chemocauterization procedure was performed by two pediatric pulmonologists by applying a trichloroacetic acid–soaked cotton swab directly to the fistula opening.
• Patients were divided into three groups based on fistula characteristics: isolated congenital TEF (n = 1), medium-sized RTEF (n = 10), and large RTEF (n = 3).
• Postoperative follow-up included clinical assessment and bronchoscopy to evaluate fistula closure and detect complications.

TAKEAWAY

• A single chemocauterization procedure achieved successful fistula closure in all patients in the medium-size RTEF group; 80% of patients underwent systematic follow-up bronchoscopy, which confirmed successful RTEF closure.
• In the large RTEF group, one patient required 3 procedures for complete closure and 2 patients required nasojejunal feeding after endoscopic treatment.
• The patient requiring multiple procedures developed aspiration pneumonia 1 month after the initial chemocauterization, complicated by acute respiratory distress syndrome.
• One patient with isolated congenital TEF underwent endoscopic chemocauterization as the primary treatment approach, without prior surgical repair.

IN PRACTICE

"Our findings contribute to the scarce but growing body of evidence suggesting that endoscopic de-epithelization techniques may be considered a first-line treatment option for carefully selected cases of RTEF, potentially reducing the morbidity associated with surgical repair," the authors of the study wrote.

SOURCE

The study was led by Loraine Fabri, Department of Respiratory Medicine, Queen Fabiola Children's University Hospital, Brussels University Hospital, Université Libre de Bruxelles in Brussels, Belgium. It was published online on July 27 in Pediatric Pulmonology.

LIMITATIONS

The sample size was small, with patients from a single center. A surgical repair comparator group for those who underwent endoscopic chemocauterization was lacking.

DISCLOSURES

No specific funding sources were reported for this study. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.