Page 42 - ECBIP 2021_Program

6th European Congress ECBIP 15 - 17
Book of Abstracts
for Bronchology and
Interventional Pulmonology ATHENS - GREECE 2021
OCTOBER
MODERATED e-POSTER SESSION 01:
Central Airway management
BRONCHOSCOPIC MANAGEMENT OF RECURRENT TRACHEOESOPHAGEAL FISTULA
Maggie Louis Naguib1, Basma Magdy Ibrahim1, Mohamed M. Elbarbary1, Khaled S. Abdullateef1
Cairo University Pediatric Hospital, Cairo, Egypt
PP05
Introduction: Recurrent tracheo-esophageal fistula (rTEF) after esophageal atresia with tracheoesophageal fistula (EA/ TEF) repair is reported in 9-19% [1]. Here, we present a 2-year old female, who was diagnosed with rTEF after the guardians had reported persistent gaseous stomach distention and several episodes of chest infections necessitating hospital admissions and oxygen support. Simultaneous bronchoscopy and endoscopy diagnosed rTEF. In attempts to occlude the fistula non-surgically, the patient was scheduled for several sessions of endoscopy which failed to treat that rTEF. We aimed to avoid the risk of surgery by occluding the fistula by the bronchoscope using trichloroacetic acid as a chemo- cauterizing agent [2].
Methodology: After re-confirmation of rTEF, a rigid bronchoscope was introduced just above the fistula and the mucosa was brushed vigorously to create a raw area.Afterwards,50% trichloroacetic acid was applied using gauze in the fistulous tract for 30 seconds thrice.This procedure was repeated again after 8 weeks.
Results: After the procedure, which had taken one hour in duration, the patient was admitted in the intensive care unit for 5 days, 1st 48-hours on ventilator, till improvement of the chest condition. After 6 weeks from the first attempt, guardians reported improvement in the chest condition along with no gaseous stomach distention. Also, no choking or aspiration were detected with gradual onset of oral intake.
Conclusion: Bronchoscopy could be a better option for rTEF to avoid the surgery for these challenging conditions.The
bronchoscopy is considered a safe non invasive tool, with less interventional procedure time as well as hospital stay.
References:
1. Patria M, Ghislanzoni S, Macchini F, Lelii M, Mori A, Leva E, Principi N, Esposito S. Respiratory morbidity in children with repaired congenital esophageal atresia with or without tracheoesophageal fistula. International journal of environmental research and public health. 2017 Sep 27;14(10):1136.
2. Lelonge Y, Varlet F, Varela P, Saitúa F, Fourcade L, Gutierrez R, Vermesch S, Prades JM, Lopez M. Chemocauterization with trichloroacetic acid in congenital and recurrent tracheoesophageal fistula: a minimally invasive treatment. Surgical endoscopy. 2016 Apr 1;30(4):1662-6.
Figure 1: Bronchoscopic view of recurrent fistula. Figure 2: Fistula after trichloroacetic acid application.
42 6th European Congress for Bronchology and Interventional Pulmonology