title: Video: argon plasma coagulator in a 2-month-old child with tracheoesophageal fistula.
abstract: 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.
authors.affiliation: Department of Pediatrics, Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, University Hospital Umberto I, Viale Regina Elena, 324-00161 Rome, RM, Italy. giovanni.dinardo@uniroma1.it
authors.forename: Giovanni Di
authors.initials: GD
authors.lastname: Nardo
authors.forename: Salvatore
authors.initials: S
authors.lastname: Oliva
authors.forename: Maria
authors.initials: M
authors.lastname: Barbato
authors.forename: Marina
authors.initials: M
authors.lastname: Aloi
authors.forename: Fabio
authors.initials: F
authors.lastname: Midulla
authors.forename: Mario
authors.initials: M
authors.lastname: Roggini
authors.forename: Francesco
authors.initials: F
authors.lastname: Valitutti
authors.forename: Simone
authors.initials: S
authors.lastname: Frediani
authors.forename: Salvatore
authors.initials: S
authors.lastname: Cucchiara
mesh_terms: D057908:Argon Plasma Coagulation; D002675:Child, Preschool; D006801:Humans; D008297:Male; D014138:Tracheoesophageal Fistula / Q000601:surgery*