title: Esophageal atresia with proximal tracheoesophageal fistula: a missed diagnosis.
abstract: OBJECTIVE
  This retrospective study was performed to compare the relative incidence of esophageal atresia (EA) with proximal tracheoesophageal fistula (PTEF) at our institution with those reported in literature and to test the hypothesis that our higher relative incidence is caused by the routine use of tracheoscopy.
  
  
  METHODS
  A total of 204 children with EA were managed at our institution from 1981 to 2012. The type of EA and the diagnostic assessment were noted, and the relative incidence of PTEF was calculated. For patients managed from 1981 to 2003 (Group 1), the PTEF was diagnosed by contrast esophagogram or during surgical repair. For those born after 2004 (Group 2), the final diagnosis was made by routine rigid tracheoscopy performed preoperatively. The relative incidence of PTEF was compared between these two groups and with those reported in 15 selected published large series, encompassing 4197 patients with EA.
  
  
  RESULTS
  Of 204 patients with EA, 10 had PTEF, with a relative incidence of 4.9%, statistically higher than those reported in reference group (1.14%, P<0.001). The routine employ of tracheoscopy involved a higher relative incidence of PTEF (Group 2=11.11%, Group 1=3.14%, P=0.038). The age of diagnosis of PTEF was 2.8 days for children of Group 2 and 4.2 days for Group 1 (P=0.038).
  
  
  CONCLUSIONS
  The presence of the proximal TEF should be always ruled out before surgery. Routine employ of rigid tracheoscopy avoids delay of the diagnosis, improves diagnostic accuracy, and involves a higher relative incidence of proximal fistul. This procedure should be recommended in children undergoing EA repair.
authors.affiliation: Department of Paediatric Surgery, Fondazione IRCCS Ca' Granda, Ospedale, Maggiore Policlinico, Padiglione Alfieri (Chirurgia Pediatrica), Via Commenda, 10 20122 Milano, Italy. parfil@hotmail.it
authors.forename: Filippo
authors.initials: F
authors.lastname: Parolini
authors.forename: Anna
authors.initials: A
authors.lastname: Morandi
authors.forename: Francesco
authors.initials: F
authors.lastname: Macchini
authors.forename: Lorena
authors.initials: L
authors.lastname: Canazza
authors.forename: Maurizio
authors.initials: M
authors.lastname: Torricelli
authors.forename: Andrea
authors.initials: A
authors.lastname: Zanini
authors.forename: Ernesto
authors.initials: E
authors.lastname: Leva
mesh_terms: D001999:Bronchoscopy; D057210:Delayed Diagnosis / Q000517:prevention & control / Q000706:statistics & numerical data; D003951:Diagnostic Errors / Q000517:prevention & control / Q000706:statistics & numerical data; D004724:Endoscopy; D004933:Esophageal Atresia / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D012189:Retrospective Studies; D014138:Tracheoesophageal Fistula / Q000175:diagnosis* / Q000453:epidemiology
keywords: EA; Esophageal atresia; Newborns; PTEF; Proximal tracheoesophageal fistula; SD; TEF; Tracheobronchoscopy; esophageal atresia; proximal tracheoesophageal fistula; standard deviation; tracheoesophageal fistula