Endoscopic Trichloroacetic Acid Chemocauterization for Recurrent Tracheoesophageal Fistula: A Single-Center...

Tracheoesophageal fistula (TEF) is a rare congenital anomaly commonly associated with esophageal atresia (EA-TEF). Management involves early surgical repair. TEF recurrence is not rare and repeat surgery carries significant complication risks. Endoscopic treatment is an alternative to iterative surgery. This retrospective case series describes the diagnosis, management, and outcomes of children treated with endoscopic chemocauterization for RTEF after EA-TEF surgical repair (RTEF) or isolated congenital TEF in our center.

We reviewed the charts of all patients who underwent endoscopic treatment for TEF at a single pediatric tertiary center from 2016 to 2023. Patients were divided into three groups: isolated congenital TEF, medium-sized or large recurrent RTEF. Chemocauterization was performed via rigid bronchoscopy by applying a trichloroacetic acid (TCA)-soaked cotton swab to the fistula. Postoperative follow-up included clinical assessment and bronchoscopy as indicated by clinical evolution.

Chemocauterization was performed on 13 patients following diagnosis of RTEF. A single chemocauterization procedure was sufficient for 12 patients, while three procedures were required for one patient. This patient developed aspiration pneumonia 1 month after his initial chemocauterization. No complications were observed in other patients. One patient was diagnosed with an isolated congenital TEF and benefited from endoscopic treatment as the primary approach, with a successful single procedure.

Endoscopic chemocauterization using TCA appears to be a safe and effective technique for managing RTEF. This study also presents a successful first-line endoscopic treatment of an isolated congenital TEF using chemocauterization. Further studies are needed to compare its effectiveness with surgery.