Long-Term Results of Endoscopic Diathermy Coagulation of Recurrent Tracheoesophageal Fistula

Abstract

Purpose:

Repair of recurrent tracheoesophageal fistula (RTEF) can be a technically challenging problem. Various forms of endoscopic treatment of RTEF have been described. The exact role of endoscopic treatment in the management of RTEF remains unestablished. This study describes the long-term clinical outcome of patients who have undergone endoscopic diathermy coagulation (EDC) of RTEF.

Materials and methods:

EDC of RTEF was performed in seven patients by a single surgeon between 1993 and 1999. In the first 3 patients, EDC was performed because formal thoracotomy was either considered too risky or had been unsuccessful. In the last 4 cases, however, it was used as the procedure of choice. EDC was performed by applying a standard coagulation current to the tracheal end of the RTEF. The exposed tip of the metal stent of a 3F ureteric catheter was positioned at the mouth of the fistula via a rigid bronchoscope. Sufficient current was applied to the proximal end of the stent to cause coagulation of the mucosa, and coaptation of the margins of the tracheal end of the RTEF.

Results:

The mean followup period has been 4.42 years (16 months to 8 years). One patient has been lost to follow up. Thirteen EDC procedures have been performed on the remaining 6 patients with RTEF. Five out of these 6 patients have been successfully managed with EDC. Three patients have been managed solely with EDC. Thoracotomy for failure to control symptoms with EDC has so far been required in only one patient. Four out of the 5 cases successfully managed with EDC required more than one attempt (maximum number of attempts, 3).

Conclusions:

EDC is technically simple to perform and tolerated easily (requiring only an overnight stay in hospital). It is safe, can be repeated without added risk, and does not require expensive equipment. Therefore EDC should be considered as an option in all cases of RTEF.