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Tracheoesophageal fistula.

Michael F Reed1, Douglas J Mathisen

  • 1Division of Thoracic Surgery, University of Cincinnati College of Medicine, University of Cincinnati Medical Center, 231 Albert B. Sabin Way, P.O. Box 670558, Cincinnati, OH 45267-0558, USA. michael.reed@uc.edu

Chest Surgery Clinics of North America
|May 21, 2003
PubMed
Summary

Tracheoesophageal fistula (TEF) is a rare complication, often from intubation. Management focuses on airway protection, nutrition, and surgical repair for nonmalignant cases, while malignant TEF requires palliative stenting or bypass for symptom relief.

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Area of Science:

  • Thoracic surgery
  • Gastroenterology
  • Pulmonology

Background:

  • Acquired tracheoesophageal fistula (TEF) is a rare complication, frequently resulting from intubation-related tracheal injury.
  • Patients often present with increased secretions, pneumonia, and aspiration, particularly when on mechanical ventilation.

Purpose of the Study:

  • To review the causes, diagnosis, and management of acquired tracheoesophageal fistulas (TEF).
  • To outline strategies for both nonmalignant and malignant TEF, emphasizing surgical and palliative interventions.

Main Methods:

  • Diagnostic evaluation involves bronchoscopy and esophagoscopy.
  • Management strategies include tracheostomy cuff placement, gastrostomy/jejunostomy tubes for nutrition, and surgical repair (e.g., tracheal resection and reconstruction).

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  • For malignant TEF, palliative options like esophageal bypass or stenting are considered.

    • Main Results:

    • Nonmalignant TEF repair, often via tracheal resection and reconstruction, can achieve high success rates when performed after weaning from mechanical ventilation.
    • Malignant TEF has a poor prognosis; palliative treatments aim to improve quality of life and manage symptoms.
    • Esophageal bypass or stenting can improve survival and quality of life in malignant TEF patients.

    Conclusions:

    • Prompt diagnosis and appropriate management, including surgical repair for nonmalignant TEF and palliative interventions for malignant TEF, are crucial.
    • Surgical repair of nonmalignant TEF is best delayed until patients are off mechanical ventilation.
    • Palliative esophageal bypass or stenting offers significant benefits for patients with malignant TEF.