polidocanol and Esophageal-Atresia

We present a difficult case of a recurrent tracheoesophageal fistula following primary surgical repair of esophageal atresia. After four unsuccessful attempts to close the fistula, which included three thoracotomies and one endoscopic obliteration using fibrin glue, successful recurrent tracheoesophageal fistula closure was attained with the endoscopic application of enbucrilate (Histoacrylate) combined with polidocanol. Enbucrilate was applied into the lumen of the fistula by bronchoscopy, and polidocanol (Sclerovein) was injected into the esophageal submucosa around the fistula by esophagoscopy. Three years after this treatment, the fistula remains apparently closed.

Topics: Bronchoscopy; Enbucrilate; Esophageal Atresia; Esophagoscopy; Humans; Infant, Newborn; Male; Polidocanol; Polyethylene Glycols; Postoperative Complications; Recurrence; Reoperation; Tissue Adhesives; Tracheoesophageal Fistula

We report a successful endoscopic obliteration of a large recurrent tracheoesophageal fistula (diameter 0.6 cm, length 2.0 cm) in a 12-year-old girl, using a combination of Histoacryl (n-butyl-z-cyanoacrylate) and Aethoxysclerol injected through a polyethylene catheter. The severe pulmonary infection, which rendered surgery potentially life threatening, disappeared after the endoscopic closure. Since the obliteration, now over 12 months ago, the girl is asymptomatic. Endoscopic obliteration is a worthwhile technique and should be considered as an alternative to surgery in patients presenting with a complicated recurrent tracheoesophageal fistula.

Topics: Anesthesia, General; Child; Enbucrilate; Esophageal Atresia; Esophagoscopy; Female; Humans; Polidocanol; Polyethylene Glycols; Postoperative Complications; Recurrence; Tissue Adhesives; Tracheoesophageal Fistula