Thulium LASER for endoscopic closure of tracheoesophageal fistula in esophageal atresia's spectrum: an appropriate tool?
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In brief
In brief
Retrospective study of 11 pediatric patients evaluates Thulium LASER for endoscopic closure of tracheoesophageal fistulas. Success rates differed significantly: 50% for recurrent TEF after esophageal atresia repair versus only 20% for H-type fistulas, with one severe complication. Authors recommend open surgery as first-line for H-type fistulas.
Written by the GCMD Library team from the article.
Abstract
Purpose
To report our experience with endoscopic Thulium LASER for treatment of recurrent TEF after EA surgery, and for H-Type fistulas.
Methods
A retrospective chart review of consecutive patients undergoing standardized endoscopic closure as first line therapy of recurrent tracheoesophageal fistula (RTEF) and H-type fistula using Thulium LASER, from 2013 to 2019, in a pediatric tertiary care center. Control endoscopic procedure was systematically performed. If persistence of the TEF was noted an external approach was performed. Patient demographics, medical history, symptoms, TEF type, treatment modalities, complications and outcomes were collected.
Results
Eleven patients with tracheoesophageal fistula were included: six RTEF after primary repair of esophageal atresia and five H-type fistulas. The average age at endoscopic treatment was 19months (SD 23months, range 13days–63months). Closure of the fistula after single endoscopic procedure with Thulium LASER was obtained in 3 RTEF (50%) and 1 H-type fistula (20%). Six patients with failure of endoscopic treatment were cured after a single external procedure without any complications. One child, treated for H-type fistula, presented a severe complication of Thulium LASER treatment. Median follow-up after last repair was 24months (range: 14–72months). All fistulas were successfully treated.
Conclusions
In H-Type fistula, success rate of Thulium LASER is only 20% and thus should not be used. In contrast, in RTEF, success rate of 50% is achieved, avoiding as many open procedures, and Thulium LASER could be considered as first line treatment. In any case, open surgery is safe and efficient and can be considered as a first-line treatment for H-type fistulas, and as a salvage treatment for endoscopic treatment failures.
Levels of Evidence
Level IV.