Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, University Hospital Umberto I, Viale Regina Elena, 324-00161 Rome, RM, Italy.
Surg Endosc. 2012 Sep;26(9):2678-80. doi: 10.1007/s00464-012-2214-7. Epub 2012 Apr 5.
A 2 month-old boy was admitted to the authors' hospital because of regurgitation and persistent cough during breastfeeding. A chest X-ray examination and a barium esophagogram disclosed small amounts of barium passing in the trachea, suggesting a tracheoesophageal fistula (TEF). Bronchoscopy combined with upper gastrointestinal (GI) endoscopy performed with the patient under general anesthesia confirmed the fistula. The TEF was treated by injection of 1 ml Glubran 2 from the esophageal side. A nasogastric tube was placed for feedings, and 7 days later, a barium esophagogram showed a reduction of caliber but not complete closure of the TEF. Unsuccessful fistula obliteration with Glubran was attributed to technical difficulties in catheterization of the fistula orifice, mainly resulting from its close proximity to the upper esophageal sphincter and to its small caliber. Therefore, an argon plasma coagulator (APC) probe with a circumferentially oriented nozzle was used from the esophageal side as an alternative technique to fulgurate the residual fistula orifice (see video). A nasogastric tube was placed for feedings. Oral feeding was started 7 days later when a barium esophagogram confirmed complete fistula closure. At the 2-year follow-up visit, the boy was asymptomatic, and the barium esophagogram was negative. This report describes a case in which esophagoscopy gave a clear view of the fistula due to its direction from esophagus to trachea. Complete fistula obliteration was not obtained with Glubran. However, APC was successfully used to close the residual fistula orifice. The authors suggest that APC can be used as an alternative endoscopic technique to repair TEF when other techniques fail.
一名 2 个月大的男婴因哺乳时反流和持续咳嗽而被收入作者医院。胸部 X 光检查和钡食管造影显示少量钡剂进入气管，提示存在食管气管瘘（TEF）。支气管镜检查结合全身麻醉下的上消化道（GI）内镜检查证实了瘘管的存在。通过从食管侧注入 1ml Glubran 2 来治疗 TEF。放置鼻胃管进行喂养，7 天后，钡食管造影显示瘘管口径减小，但未完全闭合。Glubran 未能成功闭塞瘘管，原因是瘘管口的导管插入技术困难，主要是由于其靠近食管上括约肌和口径较小。因此，从食管侧使用带有环形喷嘴的氩等离子凝固（APC）探头作为替代技术来烧灼残余瘘管口（见视频）。放置鼻胃管进行喂养。7 天后，当钡食管造影证实完全闭合瘘管时，开始口服喂养。在 2 年的随访中，男孩无症状，钡食管造影阴性。本报告描述了一例因瘘管从食管向气管方向而通过食管镜可清晰观察到瘘管的病例。Glubran 未能完全闭塞瘘管。然而，APC 成功用于封闭残余瘘管口。作者建议，当其他技术失败时，APC 可作为修复 TEF 的替代内镜技术。
