Pre-op Rigid Tracheobronchoscopy (TBS) for the Diagnosis of Tracheomalacia (TM) in Oesophageal Atresia (OA) Patients | Retrospective cohort | Jun 2013 - Dec 2022 | Netherlands | 79 Patients | -was born with OA | -TBS before OA correction | -followed for >12 months | 69 patients type-C OA | Pre-op: 33 patients had TM (7 severe TM) | Definite TM*: 21 patients (15 severe TM) | TM symptoms in 12 months: 41 patients | Pre-op TBS for the presence of post-op TM | Sensitivity = 50.0% Specificity = 67.6% | *Definite TM: post-op diagnosed through TBS | Conclusion: Over half of oesophageal atresia patients experienced tracheomalacia symptoms. Preoperative tracheobronchoscopy, though routine, has limited predictive value for postoperative tracheomalacia. | https://pubmed.ncbi.nlm.nih.gov/39089893/ | van Hal ARL et. al. | Department of Paediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, the Netherlands | @EmGooteeMD | @StayCurrentMD | Cincinnati Children's | Journal of Pediatric Surgery
The Value of Preoperative Rigid Tracheobronchoscopy for the Diagnosis of Tracheomalacia in Oesophageal Atresia Patients
Infographic · Dec 2024 · 1 min read
In brief
In brief
This retrospective study of 79 oesophageal atresia patients found that preoperative rigid tracheobronchoscopy had limited predictive value for postoperative tracheomalacia, with 50% sensitivity and 68% specificity. Over half of patients developed TM symptoms within twelve months despite routine preoperative screening.
- 52% of OA patients developed TM symptoms within 12 months, most commonly stridor/wheezing and harsh barking cough.
- Preoperative rigid TBS has limited predictive value: 50% sensitivity and 68% specificity for postoperative tracheomalacia.
- 42% showed TM on preoperative TBS, but only 27% had definite TM on postoperative bronchoscopy—discordance is common.
- Severe TM was more often identified postoperatively (15 patients) than preoperatively (7 patients), suggesting progression.
- Clinical characteristics cannot reliably predict which OA patients will develop postoperative TM—surveillance is essential.
Written by the GCMD Library team from the infographic.
The infographic uses a teal and yellow color scheme with three main sections. The top section features the title on a teal banner. The middle section shows study details on the left with a Netherlands map, patient statistics in the center, and a clinician illustration on the right. The bottom section displays clinical findings with a healthcare worker illustration on the left, detailed statistics in the center, and a yellow conclusion banner at the bottom.
Anne-Fleur R.L. van Hal, Irene P. Aanen, René M.H. Wijnen, Bas Pullens, John Vlot
Background: Oesophageal atresia (OA) is often accompanied by tracheomalacia (TM). The aim of this study was to evaluate its presence in OA patients during routine rigid tracheobronchoscopy (TBS) before primary correction and compare this to postoperative TBS and clinical signs of TM.
Methods: This retrospective cohort study included patients born with OA between June 2013 and December 2022 who had received a TBS before OA correction and had been followed for at least twelve months. Definite TM was postoperatively diagnosed through TBS, and probable TM was defined as having symptoms of TM.
Results: We analysed data from 79 patients, of whom 87% with OA type C. Preoperatively, TM was observed in 33 patients (42% of all patients), seven of whom had severe TM. Definite TM was observed in 21 patients (27%), of whom 15 had severe TM. Forty-one patients (52% of all patients) had developed symptoms of TM within twelve months, including harsh barking cough (n = 15), stridor and/or wheezing (n = 20), recurrent respiratory insufficiency (n = 11), or needing airway surgery (n = 7). The sensitivity of preoperative TBS for the presence of postoperative (definite and probable combined) TM is 50.0%, 95% CI [35.2–64.8], and the specificity 67.6%, 95% CI [51.7–81.1]. Clinical characteristics did not differ between the patients with or without postoperative TM.
Conclusions: More than half of the studied patients with OA experienced symptoms of TM. While preoperative TBS is routinely performed prior to surgical OA correction, its predictive value for the presence of postoperative TM remains limited.