Background

Esophageal atresia and tracheo-esophageal fistula (TEF), a well described congenital anomaly of the aero-digestive tract, commonly presents with inability to swallow and feed immediately after birth. However, diagnosis of recurrent or isolated TEF can be challenging and requires a combination of endoscopic and contrast studies. We describe a hitherto unreported technique of low flow intermittent oxygen insufflation into the suspicious tract and examine its safety and diagnostic yield for identification of occult TEF.

Methods

A retrospective single center cohort study, analyzing case notes of patients with TEF who underwent bronchoscopic oxygen insufflation for suspected recurrent or isolated TEF between 2006-2019 at a tertiary pediatric hospital.

Results

One-hundred and seven patients with TEF underwent 142 bronchoscopies during the study period. Of these, 22 patients underwent 28 bronchoscopies with oxygen insufflation. Twelve (43%) open fistulas were identified; of these, 9 (75%) were found using oxygen insufflation, revealing the fistula in 4/9 (44%) cases that had not been apparent using simple bronchoscopic visualization alone. One fistula was missed with multiple investigations, including bronchography and found only using oxygen insufflation. No complications were encountered.

Conclusions

Recurrent or isolated TEF may be missed using ordinary flexible bronchoscopy and imaging studies. Low flow oxygen insufflation can be applied safely and may detect otherwise occult TEF.

中文翻译：

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低流量间歇性支气管镜注氧以识别隐匿性气管食管瘘

背景

食管闭锁和气管食管瘘 (TEF) 是一种很好描述的先天性呼吸消化道异常，通常表现为出生后无法立即吞咽和进食。然而，复发性或孤立性 TEF 的诊断可能具有挑战性，需要结合内窥镜和对比研究。我们描述了一种迄今未报道的将低流量间歇性氧气吹入可疑管道的技术，并检查其安全性和诊断率，以识别隐匿性 TEF。

方法

一项回顾性单中心队列研究，分析了 2006 年至 2019 年期间在一家三级儿科医院接受支气管镜吸氧治疗疑似复发性或孤立性 TEF 的 TEF 患者的病例记录。

结果

在研究期间，107 名 TEF 患者接受了 142 次支气管镜检查。其中，22 名患者接受了 28 次支气管镜检查并进行了氧气注入。发现十二个（43%）开放性瘘管；其中 9 例 (75%) 是使用吹氧发现的，4/9 (44%) 的病例中发现瘘管，而仅使用简单的支气管镜检查并不明显。包括支气管造影在内的多项检查都遗漏了一个瘘管，仅在使用氧气吹入时才发现。没有遇到并发症。

结论

使用普通的软式支气管镜检查和影像学检查可能会漏诊复发性或孤立性 TEF。可以安全地应用低流量氧气吹入，并且可以检测到其他隐匿性 TEF。