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Tracheoscopic Findings and Their Impact on Respiratory Symptoms in Children with Esophageal Atresia
Janina Fischer1,2, Johannes Balleisen1,2, Josef Holzki3
1Medical Faculty, Department of Pediatrics and Adolescent Medicine, University Hospital of Cologne, Cologne, Germany.
Insights
Tracheomalacia is common in esophageal atresia with tracheoesophageal fistula (EA-TEF) and often persists after surgery. Severe tracheal collapse (>80%) with specific symptoms indicates high risk for life-threatening events.
Area of Science:
- Pediatric Surgery
- Respiratory Medicine
- Gastroenterology
Background:
- Esophageal atresia (EA) frequently co-occurs with tracheobronchial malformations.
- These malformations can cause stridor, bronchitis, and dangerous apnea post-surgery.
- Identifying tracheomalacia in EA-tracheoesophageal fistula (TEF) patients is crucial for managing airway complications.
Purpose of the Study:
- To assess tracheomalacia in EA-TEF patients pre- and post-operatively.
- To correlate endoscopic findings with clinical airway symptoms.
- To identify risk factors for severe airway compromise.
Main Methods:
- Retrospective analysis of 595 tracheoscopies in 362 EA-TEF patients (1983-2002).
- Evaluation of tracheal lumen, TEF location, tracheal pulsations, and symptoms.
- Quantification of tracheal collapse percentage.
Main Results:
- Tracheomalacia incidence is higher in EA-TEF (Gross B-D) than EA alone (Gross A).
- Tracheal collapse did not significantly change after esophageal repair.
- Patients with cyanosis/apnea had 89% tracheal collapse; symptomatic vs. asymptomatic patients showed similar collapse (37% vs. 33%).
Conclusions:
- Tracheomalacia is often independent of surgical repair.
- Tracheoscopy (% tracheal collapse) is recommended for diagnosis.
- Tracheal collapse >80% with ventral pulsation and apnea/cyanosis signals high risk, warranting surgical consideration.
Introduction:
Esophageal atresia (EA) is often accompanied by tracheobronchial malformations leading to stridor, recurrent bronchitis, and occasionally to life-threatening obstructive apnea after surgical repair. The aim of this study was to identify the presence of tracheomalacia in patients with EA and tracheoesophageal fistula (TEF) pre- and postoperatively and to find endoscopic correlates leading to clinical airway symptoms.
Methods:
In a cohort of 362 patients with EA-TEF who underwent 595 tracheoscopies at the Children's Hospital of Cologne between January 1983 and December 2002, impaired tracheal lumen, localization of TEF, tracheal pulsations, and corresponding clinical symptoms were retrospectively analyzed.
Results:
The incidence of tracheomalacia was higher in patients with EA and TEF (Gross B-D) compared with patients with EA alone (Gross A) and average tracheal collapse does not significantly change before and after surgical repair of the esophagus in all types. Patients with cyanosis while eating and obstructive apnea presented with an average tracheal collapse of 89%. The presence of respiratory symptoms such as cough, stridor, or bronchitis was not associated with a higher grade of tracheal collapse compared with patients without any airway symptoms (average tracheal collapse of 37% in symptomatic patients vs. 33% in nonsymptomatic patients).
Conclusion:
Tracheomalacia tends to be present independently of surgical procedure. Tracheomalacia should be measured by tracheoscopy (in % of tracheal collapse). Patients with a tracheal collapse of >80%, a ventral pulsation, and obstructive apnea or cyanosis in combination, are at risk for life-threatening situations and further surgical treatment should be considered.
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