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Tracheoesophageal Fistula (TEF)

by Brian Alverson, MD
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    00:01 In this lecture, we’re going to discuss tracheoesophageal fistula.

    00:06 So TEF or tracheoesophageal fistula is an abnormal congenital connection between the trachea and the esophagus.

    00:16 There are five types.

    00:19 Type 1 is by far the most common.

    00:22 This is an atresia with a fistula between the distal esophagus and the trachea as is pictured here.

    00:29 You can see the esophagus basically stops.

    00:33 The stomach is connected to trachea.

    00:36 So these patients will show up very, very early.

    00:39 Their first meal, it ain’t going anywhere. They’ll spit up.

    00:44 A smaller percentage, 8%, have a completely atretic stomach and esophagus.

    00:50 In other words, there’s not fistula.

    00:52 There’s simply a blind and looped esophagus and a blind and looped stomach.

    00:57 These infants should have no gas bubbles in their intestines on an X-ray, and will spit up very quickly after eating.

    01:03 This represents 8%.

    01:05 You can see we’ve already accounted for most of tracheoesophageal fistula.

    01:10 Almost the rest are the third type and this is an H type of fistula.

    01:16 The H type fistula is basically a connection between the trachea and the esophagus.

    01:23 There’s a little bridge.

    01:25 So these infants are interesting and that they can present a little bit later on.

    01:31 Basically, at some point, their gastric contents do dribble into the lungs and they get respiratory distress often with eating.

    01:39 So this is fistula without any atresia compared too the last one, which was an atresia without any fistula.

    01:46 There are two other very rare types that you might hear about.

    01:50 One is where the proximal esophagus feeds into the trachea.

    01:54 There is no path to the stomach.

    01:57 The other is the same except there is a path to the stomach, the proximal esophagus enters the trachea and then the distal esophagus arises from the trachea a little bit farther down.

    02:10 When we see TEF, about half of patients will have an associated anomaly.

    02:16 An example might be CHARGE syndrome.

    02:19 In CHARGE syndrome, they may have coloboma as you can see in this patient here with that black pupil that’s extending down in the patient’s left eye.

    02:28 They may have heart defects or an atresia such as choanal atresia.

    02:33 Or they may have retardation or what we like to call intellectual disability.

    02:38 They may have genital malformations or they may have ear anomalies.

    02:42 CHARGE, C-H-A-R-G-E, and those are symptoms they may have.

    02:47 They may also have tracheoesophageal fistula.

    02:51 Another defect more classically associated with tracheoesophageal fistula is VACTERL.

    02:57 Again, each of these letters count for a symptom that these patients have.

    03:01 V is vertebral defects.

    03:03 A is anal atresia.

    03:05 C is cardiac defects, particularly a VSD and the TE stand for tracheoesophageal fistula.

    03:14 They also have renal anomalies or malformations and they have limb defects such as radial dysplasia, polydactyly or syndactyly.

    03:24 So most TEF presents almost immediately after birth.

    03:30 These patients have food that cannot get into the stomach in most cases.

    03:35 This results in immediate emesis and rapid dehydration outside of the uterus.

    03:41 Additionally, gastric contents may enter the lungs resulting in respiratory distress.

    03:49 So the diagnosis of TEF is usually made because it’s impossible to get the NG tube into the stomach.

    03:56 These infants are sick.

    03:58 We place an NG in and we can’t get it into the stomach.

    04:01 Instead it coils up in the proximal esophagus.

    04:04 So we put in the NG, we take an x-ray and, wow, look at that NG, it didn’t go in.

    04:09 Maybe this child has a TEF.

    04:12 Alternatively we can make a more definitive diagnosis by doing endoscopy.

    04:18 We scope, we look down there, it’s a blind loop.

    04:22 So the H type fistula is the one I think that comes to mind the most often because it’s more subtle.

    04:31 This is only four percent of all cases of TEF.

    04:35 But this one can present later on in life.

    04:38 It’s basically a fistula that’s small.

    04:41 So there can be a delay in diagnosis.

    04:44 Patients present with coughing, wheezing, and struggling with feeds and reflux.

    04:51 As you can see in this picture, the food goes down the esophagus and then somehow gets into the trachea and can cause problems.

    04:59 Some of the food keeps going.

    05:03 So that’s my summary of TEF in children.

    05:07 Thanks for your time.


    About the Lecture

    The lecture Tracheoesophageal Fistula (TEF) by Brian Alverson, MD is from the course Neonatology (Newborn Medicine). It contains the following chapters:

    • Tracheoesophageal Fistula (TEF)
    • CHARGE Syndrome and VACTERL

    Included Quiz Questions

    1. Proximal esophageal atresia with fistula between distal esophagus and trachea
    2. H-type fistula
    3. Atresia without a fistula
    4. Proximal esophagus feeds into trachea, no path to stomach
    5. Proximal esophagus enters trachea, distal esophagus arises from trachea further down
    1. 5.
    2. 1.
    3. 2.
    4. 3.
    5. 4.
    1. 8%.
    2. 6%.
    3. 4%.
    4. 10%.
    5. 12%.

    Author of lecture Tracheoesophageal Fistula (TEF)

     Brian Alverson, MD

    Brian Alverson, MD


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