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• W4253168014 abstract "We greatly appreciate the comments of Lopes et al and we thank them for their interest in our article. We read with great interest their comments about the risk of airway inflammation and/or obstruction by leakage of glue. Surgical treatment of tracheoesophageal fistula (TEF) is the primary treatment modality. However, open surgical repair has been reported to be associated with high levels of postoperative morbidity, mortality, and recurrence.1Stringer D.A. Ein S.H. Recurrent trachea-esophageal fistula: a protocol for investigation.Radiology. 1984; 151: 637-641Crossref PubMed Scopus (18) Google Scholar Recently, there have been some reports of endoscopic management of recurrent TEF; most of these reported management confined to attempts of bronchoscopy.2Meier J.D. Sulman C.G. Almond P.S. Endoscopic management of recurrent congenital tracheoesophageal fistula: a review of techniques and results.Int J Pediatr Otorhinolaryngol. 2007; 71: 691-697Crossref PubMed Scopus (79) Google Scholar, 3Tzifa K.T. Maxwell E.L. Chait P. et al.Endoscopic treatment of congenital H-type and recurrent tracheoesophageal fistula with electrocautery and histoacryl glue.Int J Pediatr Otorhinolaryngol. 2006; 70: 925-930Crossref PubMed Scopus (53) Google Scholar In our case, open surgical repair was undertaken 3 times before the patient was referred to our department. Because of the possibility of tracheomalacia and adhesions around the fistula from repeated surgical repairs, we performed an endoscopic intervention via the esophagus. As Lopes et al commented, we were concerned about pulmonary complications; therefore, endoscopic management was undertaken with the patient under general anesthesia. Additional aid from ventilator care was used during the procedure with positive pressure. During the procedure, there were no abnormal changes in O2 saturation and vital signs and no signs of histoacryl glue drainage through the endobronchial intubation tube. Because histoacryl glue coagulates within seconds after air exposure, we were positive that it would not reach the trachea or bronchus through the fistula tract. Recently, we treated another TEF patient. This patient was also treated with a histoacryl glue injection to close the fistula but without the aid of ventilator care. During and after the procedure, there were no pulmonary complications, dyspnea, and chest pain. Therefore, we suggest that an esophageal approach by using histoacryl glue for treating a recurrent TEF is safe and can be used as an alternative method. Endoscopic treatment of recurrent tracheoesophageal fistula with histoacryl glueGastrointestinal EndoscopyVol. 72Issue 6PreviewRecurrent tracheoesophageal fistulae after primary surgical repair of esophageal atresia represent a very difficult management problem. Histoacryl (enbucrilate) glue can be used endoscopically for their closure, with a high success rate, as reported previously by our group.1 The child with a recurrent tracheoesophageal fistula whose treatment we reported using endoscopic sealing with histoacryl via trachea1 is asymptomatic after 10 years, showing an excellent long-term outcome. Full-Text PDF" @default.
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• W4253168014 doi "https://doi.org/10.1016/j.gie.2010.05.012" @default.
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