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Aerodigestive Sequelae and Triple Endoscopy after Congenital Tracheoesophageal Fistula Repair in Children
Whitney Jin1,2, Eric H Chiou3, Shailendra Das4
1Department of Surgery, Division of Otolaryngology Texas Children's Hospital Houston Texas USA.
Insights
Children with repaired tracheoesophageal fistula (TEF) often have chronic cough. Triple endoscopy revealed that tracheal diverticulum, recurrent TEF, and lipid-laden macrophages (LLM) are linked to this symptom.
Area of Science:
- Pediatric Surgery
- Pulmonology
- Gastroenterology
Background:
- Children undergoing tracheoesophageal fistula (TEF) repair can experience persistent respiratory and gastrointestinal issues impacting their quality of life.
- Identifying factors associated with abnormal findings in triple endoscopy is crucial for managing these post-operative complications.
Purpose of the Study:
- To determine factors linked to positive findings during triple endoscopy in infants following neonatal TEF repair.
- To investigate the correlation between specific clinical presentations and endoscopic findings in this patient population.
Main Methods:
- A retrospective review of pediatric patients who underwent triple endoscopy after congenital TEF repair between 2011 and 2022.
- Analysis of variables including chronic cough, recurrent pulmonary infections, lipid-laden macrophages (LLM), and airway/esophageal anomalies.
- Utilized Chi-square and Kruskal-Wallis univariate analysis to assess associations.
Main Results:
- Tracheal diverticulum was associated with chronic cough, stridor, and feeding-related coughing.
- Positive lipid-laden macrophages (LLM) on bronchoalveolar lavage (BAL) correlated with chronic cough and stridor.
- Recurrent TEF was linked to chronic cough, and subglottic stenosis to prolonged intubation history.
Conclusions:
- Chronic cough in post-TEF repair patients is frequently associated with tracheal diverticulum, recurrent TEF, and positive LLM findings on triple endoscopy.
- A multidisciplinary approach is recommended for evaluating children with chronic cough and stridor after congenital TEF repair.
Abstract:
Children post-tracheoesophageal fistula (TEF) repair may present with chronic respiratory and gastrointestinal symptoms that can affect quality of life.
Objective:
To identify factors associated with positive findings on triple endoscopy following neonatal TEF repair.
Study Design:
Case series with retrospective review of patients.
Setting:
Tertiary care center aerodigestive program.
Methods:
Children with neonatally repaired congenital TEF who had a triple endoscopy between 2011 and 2022 were reviewed. The presence of chronic cough, recurrent pulmonary infections, lipid-laden macrophages (LLM), and airway and esophageal anomalies were among the variables analyzed. Chi-square and Kruskal-Wallis univariate analysis was performed.
Results:
The mean age was 4.28 ± 4.65 years old, and the most common type of TEF repaired was type C (78%). Within our cohort, 87% of patients had GERD, 60% of patients had prior esophageal dilations, and 84% of patients had tracheomalacia. Thirty-one (46.3%) patients had laryngeal cleft, of which 77.4% had a history of prior esophageal dilations (P = .01). Twenty-one (33.9%) patients had tracheal diverticulum on bronchoscopy, which was associated with chronic cough, stridor, and coughing with feeds. Patients with positive LLM on BAL were associated with presentation of chronic cough and stridor (P = .03). Recurrent TEF was associated with chronic cough. Subglottic stenosis was associated with a history of prolonged intubation (P < .05).
Conclusion:
Chronic cough was frequently reported and associated with tracheal diverticulum, recurrent TEF, and positive LLM findings on triple endoscopy in patients after congenital TEF repair. Patients presenting with chronic cough and stridor following congenital TEF repair may benefit from a multidisciplinary evaluation.
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