Endoscopic Chemocauterization with Trichloroacetic Acid for Congenital or Recurrent Tracheoesophageal Fistula in Children with Esophageal Atresia: Experience from a Tertiary Center

Holmquist, Anders; Wendt, Malin; Papatziamos, Georgios; Svensson, Jan; Wester, Tomas; Burgos, Carmen Mesas; Gahm, Caroline

doi:10.1016/j.jpedsurg.2023.10.049

Cited by 2 publications

(1 citation statement)

References 24 publications

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“…Tracheoesophageal fistula (TEF) is a rare condition in clinic that is difficult to treat. Methods for treatment of TEF include endoscopic treatment and surgical treatment[ 1 - 4 ], and no uniform and standardized surgical method has been developed. Good animal models hold great significance for studying the occurrence and development of human diseases, pathophysiological conditions, and prognosis after treatment.…”

Section: Introductionmentioning

confidence: 99%

Optimization of tracheoesophageal fistula model established with T-shaped magnet system based on magnetic compression technique

Zhang,

Mao,

Shen

et al. 2024

World J Gastroenterol

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BACKGROUND The magnetic compression technique has been used to establish an animal model of tracheoesophageal fistula (TEF), but the commonly shaped magnets present limitations of poor homogeneity of TEF and poor model control. We designed a T-shaped magnet system to overcome these problems and verified its effectiveness via animal experiments. AIM To investigate the effectiveness of a T-shaped magnet system for establishing a TEF model in beagle dogs. METHODS Twelve beagles were randomly assigned to groups in which magnets of the T-shaped scheme (study group, n = 6) or normal magnets (control group, n = 6) were implanted into the trachea and esophagus separately under gastroscopy. Operation time, operation success rate, and accidental injury were recorded. After operation, the presence and timing of cough and the time of magnet shedding were observed. Dogs in the control group were euthanized after X-ray and gastroscopy to confirm establishment of TEFs after coughing, and gross specimens of TEFs were obtained. Dogs in the study group were euthanized after X-ray and gastroscopy 2 wk after surgery, and gross specimens were obtained. Fistula size was measured in all animals, and then harvested fistula specimens were examined by hematoxylin and eosin (HE) and Masson trichrome staining. RESULTS The operation success rate was 100% for both groups. Operation time did not differ between the study group (5.25 min ± 1.29 min) and the control group (4.75 min ± 1.70 min; P = 0.331). No bleeding, perforation, or unplanned magnet attraction occurred in any animal during the operation. In the early postoperative period, all dogs ate freely and were generally in good condition. Dogs in the control group had severe cough after drinking water at 6-9 d after surgery. X-ray indicated that the magnets had entered the stomach, and gastroscopy showed TEF formation. Gross specimens of TEFs from the control group showed the formation of fistulas with a diameter of 4.94 mm ± 1.29 mm (range, 3.52-6.56 mm). HE and Masson trichrome staining showed scar tissue formation and hierarchical structural disorder at the fistulas. Dogs in the study group did not exhibit obvious coughing after surgery. X-ray examination 2 wk after surgery indicated fixed magnet positioning, and gastroscopy showed no change in magnet positioning. The magnets were removed using a snare under endoscopy, and TEF was observed. Gross specimens showed well-formed fistulas with a diameter of 6.11 mm ± 0.16 mm (range, 5.92-6.36 mm), which exceeded that in the control group (P < 0.001). Scar formation was observed on the internal surface of fistulas by HE and Masson trichrome staining, and the structure was more regular than that in the control group. CONCLUSION Use of the modified T-shaped magnet scheme is safe and feasible for establishing TEF and can achieve a more stable and uniform fistula size compared with ordinary magnets. Most importantly, this model offers better controllability, which improves the flexibility of follow-up studies.

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Section: Introductionmentioning

confidence: 99%

Optimization of tracheoesophageal fistula model established with T-shaped magnet system based on magnetic compression technique

Zhang,

Mao,

Shen

et al. 2024

World J Gastroenterol

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The intraoperative localization in recurrent tracheoesophageal fistula after esophageal atresia repair: a comparative study

Hua,

Liao,

Sun

et al. 2024

BMC Pediatr

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Background Recurrent tracheoesophageal fistula (rTEF) is a rare complication following initial esophageal atresia (EA) surgical repair, posing challenges in localization the fistula during surgery due to severe thoracic adhesions and structural ambiguity from previous operations. Objective We introduced two new localization methods for rTEF patients during surgery and aimed to compare the impact of using these localization techniques versus not using them on the surgical outcomes for rTEF patients. Methods We retrospectively analyzed the clinical data of rTEF cases that underwent thoracoscopic repair at our hospital from September 2017 to December 2024. Patients were divided into localization group and non-localization group based on whether using intraoperative localization techniques, and comparative analysis of clinical variables was conducted between groups. Results A total of 106 patients were included in this study, undergoing a total of 113 thoracoscopic rTEF repair surgeries at our center. Their fistula type included 89 cases of tracheoesophageal fistula (TEF), 19 cases of esophageal-pulmonary fistula (EPF), 3 cases of esophageal bronchial fistula (EBF), and 2 cases of combined EPF and TEF. All cases were categorized based on whether using localization techniques, resulting in the localization group ( n = 52) and the non-localization group ( n = 61). The median operation time in the localization group (2.5 h) was significantly lower than in the latter (3.0 h) ( P = 0.001), and regardless of the fistula type being TEF or EPF. Additionally, the average postoperative hospital stay was significantly shorter in the localization group (17.7 ± 7.5 days) than in the non-localization group (23.6 ± 20.0 days) regarding the fistula type of TEF ( P = 0.03). Conclusions The use of localization techniques in thoracoscopic surgery for rTEF leads to better outcomes, evidenced by reduced operation time and hospital stay, suggesting enhanced surgical accuracy and improved patient postoperative recovery. Level of evidence LEVEL III.

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Endoscopic Chemocauterization with Trichloroacetic Acid for Congenital or Recurrent Tracheoesophageal Fistula in Children with Esophageal Atresia: Experience from a Tertiary Center

Cited by 2 publications

References 24 publications

Optimization of tracheoesophageal fistula model established with T-shaped magnet system based on magnetic compression technique

Optimization of tracheoesophageal fistula model established with T-shaped magnet system based on magnetic compression technique

The intraoperative localization in recurrent tracheoesophageal fistula after esophageal atresia repair: a comparative study

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