Endoscopic treatment in pediatric patients with recurrent and H-type tracheoesophageal fistulas - A systematic review and meta-analysis

Amjad Tobia; Carolina Grau Luque; Katharina Leitmeyer; Marisa Dorling; Neil K Chadha

doi:10.1016/j.ijporl.2023.111541

Endoscopic treatment in pediatric patients with recurrent and H-type tracheoesophageal fistulas - A systematic review and meta-analysis

Int J Pediatr Otorhinolaryngol. 2023 May:168:111541. doi: 10.1016/j.ijporl.2023.111541. Epub 2023 Mar 31.

Authors

Amjad Tobia¹, Carolina Grau Luque², Katharina Leitmeyer³, Marisa Dorling⁴, Neil K Chadha⁵

Affiliations

¹ Division of Pediatric Otolaryngology-Head & Neck Surgery, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: amjad.tobia@gmail.com.
² Division of Pediatric Otolaryngology-Head & Neck Surgery, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Department of Otolaryngology, Head and Neck Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile.
³ Division of Pediatric Otolaryngology-Head & Neck Surgery, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Division of Pediatric Otolaryngology-Head & Neck Surgery, University Children's Hospital of Basel, Basel, Switzerland.
⁴ Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
⁵ Division of Pediatric Otolaryngology-Head & Neck Surgery, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.

PMID: 37043961
DOI: 10.1016/j.ijporl.2023.111541

Abstract

Objectives: Endoscopic treatments for managing recurrent tracheoesophageal fistula (rTEF) and H-type TEF are being utilized lately; however, the preferred technique is yet to be determined. We aimed to systematically review existing publications on endoscopic treatment of rTEF and H-type TEF to analyze their success and complication rates.

Methods: PRISMA guidelines were followed. MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials were comprehensively searched in accordance to a priori developed protocol, from 1975 until 2020. English, Spanish and German papers were included. Studies were independently screened and analyzed by two reviewers.

Results: 84 full texts were assessed for eligibility out of 581 screened studies, of these, 39 studies with 127 patients were eligible for inclusion (115 rTEF and 12 H-type TEF). All included studies were cases reports or case series. Overall success rate was 45% with sealant injection, 87% with de-epithelialization and 80% with sealant injection and de-epithelialization combined. The mean number of required treatments for success was 1.9 (range 1-6). Mixed effect model meta-analysis of case series with n > 1 showed that sealant injection had a significantly lower success rate of 50% (95% CI 1-99%, I² 72%) compared to de-epithelialization 90% (95% CI 72-99%, I² 27%), p = 0.007 and the combination of both techniques 87% (95% CI 68-99%, I² 11%), p = 0.02. Nine patients (7%) had transient respiratory distress. No mortalities reported.

Conclusion: Endoscopic treatment for rTEF and H-type fistula is a minimally invasive technique with favorable outcome and considerably less morbidity compared to open surgery, suggesting it as a safe and effective first line treatment option. Repeated endoscopic treatment attempts can be expected to obtain complete closure. De-epithelization techniques with or without combined tissue adhesive injection had significantly better results than sealant injection techniques alone.

Keywords: Endoscopic treatment; H-type TEF; Recurrent TEF; Sealant injection; de-epithelization.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Child
Endoscopy
Humans
Recurrence
Retrospective Studies
Tissue Adhesives*
Tracheoesophageal Fistula* / surgery

Substances

Tissue Adhesives