ENDOSCOPIC TREATMENT OF RECURRENT TRACHEOESOPHAGEAL FISTULAS - LONG-TERM RESULTS

Recurrent tracheo-oesophageal fistula (RTOF) occurs in 5%-15% of patie nts following oesophageal atresia repair. Re-thoracotomy is technicall y challenging and associated with significant morbidity, including a r efistulation rate of 10%-22%. Endoscopic occlusion of the RTOF with ti ssue adhesives (fibrin glue, Histoacryl) is reported to be safe and hi ghly effective. However, long-term results of-such therapy are absent from the literature. A postal survey of 13 institutions reporting the use of such treatment regimes for RTOF in the literature between 1974 and 1995 was performed, and data collected concerning the long-term ou tcomes of their reported patients. Eleven institutions responded to th e request for data, providing 22 patients (age range 1 month to 12 yea rs) for review. All had undergone initially successful RTOF closure by endoscopic methods and had been followed up for a median of 107 month s (range 3-264 months). There was no morbidity or mortality directly r elated to the procedure. Overall, only 55% of these endoscopically tre ated fistulas remained closed long-term. Fistula recurrence invariably occurred within 12 months of successful therapy (median 46 days, rang e 9-335). Most patients required multiple endoscopic procedures to ach ieve successful RTOF closure (median 2.0, range 1-4 attempts), althoug h significantly fewer attempts were required with fibrin glue therapy. Surgical re-exploration remains the treatment of choice in the fit ch ild. Endoscopic therapy offers a safe and elegant alternative to high- risk surgery in the sick child, although repeated treatments may be re quired for successful RTOF closure.