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Surgical Endoscopy

, Volume 26, Issue 9, pp 2678–2680 | Cite as

Argon plasma coagulator in a 2-month-old child with tracheoesophageal fistula

  • Giovanni Di NardoEmail author
  • Salvatore Oliva
  • Maria Barbato
  • Marina Aloi
  • Fabio Midulla
  • Mario Roggini
  • Francesco Valitutti
  • Simone Frediani
  • Salvatore Cucchiara
Video

Abstract

A 2 month-old boy was admitted to the authors’ hospital because of regurgitation and persistent cough during breastfeeding. A chest X-ray examination and a barium esophagogram disclosed small amounts of barium passing in the trachea, suggesting a tracheoesophageal fistula (TEF). Bronchoscopy combined with upper gastrointestinal (GI) endoscopy performed with the patient under general anesthesia confirmed the fistula. The TEF was treated by injection of 1 ml Glubran 2 from the esophageal side. A nasogastric tube was placed for feedings, and 7 days later, a barium esophagogram showed a reduction of caliber but not complete closure of the TEF. Unsuccessful fistula obliteration with Glubran was attributed to technical difficulties in catheterization of the fistula orifice, mainly resulting from its close proximity to the upper esophageal sphincter and to its small caliber. Therefore, an argon plasma coagulator (APC) probe with a circumferentially oriented nozzle was used from the esophageal side as an alternative technique to fulgurate the residual fistula orifice (see video). A nasogastric tube was placed for feedings. Oral feeding was started 7 days later when a barium esophagogram confirmed complete fistula closure. At the 2-year follow-up visit, the boy was asymptomatic, and the barium esophagogram was negative. This report describes a case in which esophagoscopy gave a clear view of the fistula due to its direction from esophagus to trachea. Complete fistula obliteration was not obtained with Glubran. However, APC was successfully used to close the residual fistula orifice. The authors suggest that APC can be used as an alternative endoscopic technique to repair TEF when other techniques fail.

Keywords

Argon plasma coagulator TEF Tracheoesophageal fistula 

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Notes

Disclosures

Giovanni Di Nardo, Salvatore Oliva, Maria Barbato, Marina Aloi, Fabio Midulla, Mario Roggini, Francesco Valitutti, Simone Frediani, and Salvatore Cucchiara have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (MOV 31748 kb)

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Giovanni Di Nardo
    • 1
    Email author
  • Salvatore Oliva
    • 1
  • Maria Barbato
    • 1
  • Marina Aloi
    • 1
  • Fabio Midulla
    • 2
  • Mario Roggini
    • 3
  • Francesco Valitutti
    • 1
  • Simone Frediani
    • 1
  • Salvatore Cucchiara
    • 1
  1. 1.Department of Pediatrics, Pediatric Gastroenterology and Liver UnitSapienza University of Rome, University Hospital Umberto IRomeItaly
  2. 2.Pediatric Emergency UnitSapienza University of Rome, Azienda Policlinico Umberto IRomeItaly
  3. 3.Pediatric Radiology UnitSapienza University of Rome, Azienda Policlinico Umberto IRomeItaly

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