Endoscopic treatment in pediatric patients with recurrent and H-type tracheoesophageal fistulas – A systematic review and meta-analysis. (May 2023)

• Record Type: Journal Article
• Authors: Tobia, Amjad; Luque, Carolina Grau; Leitmeyer, Katharina; Dorling, Marisa; Chadha, Neil K.
• Is Part Of: International journal of pediatric otorhinolaryngology. Volume 168(2023)
• Publication Date: 2023-05
• Subjects: Recurrent TEF -- H-type TEF -- Endoscopic treatment -- de-epithelization -- Sealant injection; TEF Tracheoesophageal fistula; Otolaryngology -- Periodicals; Pediatrics -- Periodicals; Otolaryngology -- Periodicals; Pediatrics -- Periodicals; Oto-rhino-laryngologie -- Périodiques; Pédiatrie -- Périodiques; 618.9209751
• DOI: 10.1016/j.ijporl.2023.111541
• Languages: English
• ISSNs: 0165-5876

Abstract

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%, I 2 72%) compared to de-epithelialization 90% (95% CI 72–99%, I 2 27%), p = 0.007 and the combination of both techniques 87% (95% CI 68–99%, I 2 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.