title: Chemocauterization with trichloroacetic acid in congenital and recurrent tracheoesophageal fistula: a minimally invasive treatment.
abstract: OBJECTIVE
  Recurrent tracheoesophageal fistula (RTEF) is a serious complication after primary repair of esophageal atresia and tracheoesophageal fistula (EA/TEF). Treatment of RTEF involved an open surgery by thoracotomy. Technically it is a challenge with a high morbidity and mortality. Congenital tracheoesophageal fistula (CTEF) traditionally involved an open surgery by thoracotomy or cervicotomy. Many endoscopic techniques have been developed since the past decades: thoracoscopic or bronchoscopic approach for the treatment of RTEF and CTEF; nevertheless, optimal treatment is not still determined because of few numbers of patients, short-term follow-up, and different procedures. We report our experience and evaluated the efficacy in the chemocauterization of CTEF and RTEF, with the use of 50% trichloroacetic acid (TCA) as a technique minimally invasive.
  
  
  METHODS
  From 2010 to 2014, fourteen patients with TEF (twelve RTEF and two CTEF) were selected for endoscopic management in two centers. Twelve patients had RTEF after primary repair of EA/TEF by thoracotomy approach, and two patients had CTEF in the upper pouch, diagnosed after EA/TEF (Type B) long gap, treated by thoracotomy and thoracoscopy, respectively. In all cases the diagnosis was confirmed by esophagram, bronchoscopy, and clinical evaluation. Under general anesthesia, a rigid pediatric bronchoscope with a 0° rod lens telescope and tele-monitoring was used to localize the TEF. Cotton soaked with 50% TCA was applied on the TEF during 30 s, and the procedure was repeated 3 times. The endoscopic treatment was performed monthly until TEF closure was achieved.
  
  
  RESULTS
  RTEF and CTEF were closed in all patients. The mean number of procedure in each patient was 1.8. Closure of TEF was confirmed by esophagram, bronchoscopy, and clinical evaluation. There were a bacterial pneumonia and bronchospasm as postoperative complications. Median follow-up was 41 months (8-72). All of these TEF remain completely obliterated, and all patients are asymptomatic.
  
  
  CONCLUSIONS
  Endoscopic management of congenital and recurrent TEF with the use of 50% TCA is as a minimally invasive, effective, simple and safe technique in these patients and avoids the morbidity of open surgery.
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Calvo Mackenna, Santiago, Chile.
authors.forename: Yann
authors.initials: Y
authors.lastname: Lelonge
authors.affiliation: Department of Pediatric Surgery and Urology, University Hospital of Saint Etienne, 42055, Saint-Etienne Cedex 2, France.
authors.forename: François
authors.initials: F
authors.lastname: Varlet
authors.affiliation: Department of Pediatric Surgery, University Hospital Calvo Mackenna, Santiago, Chile.
authors.forename: Patricio
authors.initials: P
authors.lastname: Varela
authors.affiliation: Department of Pediatric Surgery, University Hospital Calvo Mackenna, Santiago, Chile.
authors.forename: Francisco
authors.initials: F
authors.lastname: Saitúa
authors.affiliation: Department of Pediatric Surgery and Urology, University Hospital of Limoges, Limoges, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Fourcade
authors.affiliation: Department of Pediatric Surgery and Urology, University Hospital of Saint Etienne, 42055, Saint-Etienne Cedex 2, France.
authors.forename: Rocio
authors.initials: R
authors.lastname: Gutierrez
authors.affiliation: Department of Pediatric Surgery and Urology, University Hospital of Saint Etienne, 42055, Saint-Etienne Cedex 2, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Vermesch
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Calvo Mackenna, Santiago, Chile.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Prades
authors.affiliation: Department of Pediatric Surgery and Urology, University Hospital of Saint Etienne, 42055, Saint-Etienne Cedex 2, France. manuel.lopez@chu-st-etienne.fr.
authors.forename: Manuel
authors.initials: M
authors.lastname: Lopez
mesh_terms: D000293:Adolescent; D001999:Bronchoscopy / Q000379:methods; D002425:Cautery / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004933:Esophageal Atresia / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000601:surgery; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000379:methods; D013908:Thoracotomy; D014138:Tracheoesophageal Fistula / Q000601:surgery*; D016896:Treatment Outcome; D014238:Trichloroacetic Acid / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D014238:Trichloroacetic Acid
keywords: Chemical cautery; Congenital esophageal atresia; Endoscopic surgical procedure; Tracheoesophageal fistula; Trichloroacetic acid