Optimization of tracheoesophageal fistula model established with Tshaped magnet system based on magnetic compression technique

BACKGROUND The magnetic compression technique has been used to establish an animal model of tracheoesophageal fistula(TEF),but the commonly shaped magnets present limitations of poor homogeneity of TEF and poor model control.We designed a Tshaped magnet system to overcome these problems and verified its effectiveness via animal experiments.AIM To investigate the effectiveness of a T-shaped magnet system for establishing a TEF model in beagle dogs.METHODS Twelve beagles were randomly assigned to groups in which magnets of the Tshaped scheme(study group,n=6)or normal magnets(control group,n=6)were implanted into the trachea and esophagus separately under gastroscopy.Operation time,operation success rate,and accidental injury were recorded.After operation,the presence and timing of cough and the time of magnet shedding were observed.Dogs in the control group were euthanized after X-ray and gastroscopy to confirm establishment of TEFs after coughing,and gross specimens of TEFs were obtained.Dogs in the study group were euthanized after X-ray and gastroscopy 2 wk after surgery,and gross specimens were obtained.Fistula size was measured in all animals,and then harvested fistula specimens were examined by hematoxylin and eosin(HE)and Masson trichrome staining.RESULTS The operation success rate was 100%for both groups.Operation time did not differ between the study group(5.25 min±1.29 min)and the control group(4.75 min±1.70 min;P=0.331).No bleeding,perforation,or unplanned magnet attraction occurred in any animal during the operation.In the early postoperative period,all dogs ate freely and were generally in good condition.Dogs in the control group had severe cough after drinking water at 6-9 d after surgery.X-ray indicated that the magnets had entered the stomach,and gastroscopy showed TEF formation.Gross specimens of TEFs from the control group showed the formation of fistulas with a diameter of 4.94 mm±1.29 mm(range,3.52-6.56 mm).HE and Masson trichrome staining showed scar tissue formation and hierarchical structural disorder at the fistulas.Dogs in the study group did not exhibit obvious coughing after surgery.X-ray examination 2 wk after surgery indicated fixed magnet positioning,and gastroscopy showed no change in magnet positioning.The magnets were removed using a snare under endoscopy,and TEF was observed.Gross specimens showed well-formed fistulas with a diameter of 6.11 mm±0.16 mm(range,5.92-6.36 mm),which exceeded that in the control group(P<0.001).Scar formation was observed on the internal surface of fistulas by HE and Masson trichrome staining,and the structure was more regular than that in the control group.CONCLUSION Use of the modified T-shaped magnet scheme is safe and feasible for establishing TEF and can achieve a more stable and uniform fistula size compared with ordinary magnets.Most importantly,this model offers better controllability,which improves the flexibility of follow-up studies.

Establishment of acquired tracheoesophageal fistula using a modified magnetic compression technique in rabbits and its postmodeling evaluation

BACKGROUND Previous studies have validated the efficacy of both magnetic compression and surgical techniques in creating rabbit tracheoesophageal fistula(TEF)models.Magnetic compression achieves a 100%success rate but requires more time,while surgery,though less frequently successful,offers rapid model establishment and technical maturity in larger animal models.AIM To determine the optimal approach for rabbit disease modeling and refine the process.METHODS TEF models were created in 12 rabbits using both the modified magnetic compression technique and surgery.Comparisons of the time to model establishment,success rate,food and water intake,weight changes,activity levels,bronchoscopy findings,white blood cell counts,and biopsies were performed.In response to the failures encountered during modified magnetic compression modeling,we increased the sample size to 15 rabbit models and assessed the repeatability and stability of the models,comparing them with the original magnetic compression technique.RESULTS The modified magnetic compression technique achieved a 66.7%success rate,whereas the success rate of the surgery technique was 33.3%.Surviving surgical rabbits might not meet subsequent experimental requirements due to TEF-related inflammation.In the modified magnetic compression group,one rabbit died,possibly due to magnet corrosion,and another died from tracheal magnet obstruction.Similar events occurred during the second round of modified magnetic compression modeling,with one rabbit possibly succumbing to aggravated lung infection.The operation time of the first round of modified magnetic compression was 3.2±0.6 min,which was significantly reduced to 2.1±0.4 min in the second round,compared to both the first round and that of the original technique.CONCLUSION The modified magnetic compression technique exhibits lower stress responses,a simple procedure,a high success rate,and lower modeling costs,making it a more appropriate choice for constructing TEF models in rabbits.

Analysis of the Application Effect of Tracheal Stent Placement in the Nutritional Support Treatment of Tracheoesophageal Fistula

Objective:To evaluate and analyze the application effect of tracheal stent placement in nutritional support therapy for tracheoesophageal fistula.Methods:Clinical data of 32 patients who underwent nutritional support therapy for tracheoesophageal fistula in our hospital from September 2021 to September 2022 were collected,and all patients underwent tracheal silicone stenting,comparing dyspnea classification and Karnofsky score before and after stenting,and conducting post-treatment follow-up.Results:In 32 patients with tracheoesophageal fistula,dyspnea grading improved from grades III and IV to grades 0 to II.Before treatment,10 patients(31.06%)were in grade IV,17 patients(53.12%)were in grade III,and five patients(15.62)were in grade II;after treatment,13 patients(40.63%)were in grade I,12 patients(37.50%)were in grade I,and seven patients(21.87%)were in grade 0(P<0.05);Karnofsky score(37.52±4.86 before treatment)improved significantly to 71.39±8.24 one week after treatment(P<0.05).Nine patients with tracheoesophageal fistula were placed with silicone Y14-10-10 stent,11 with silicone 18-14-14 stent,three with silicone Y15-12-12,and seven with silicone stent 16-13-13.Conclusion:Silicone tracheobronchial stent placement for the treatment of tracheoesophageal fistula is technically feasible,simple,and safe,with reliable near-term efficacy,and is worthy of popularization and application.

Congenital tracheoesophageal fistula successfully diagnosed by CT esophagography

Tracheoesophageal fistula （TEF） or bronchoesophageal fistula may be congenital, inflammatory, neoplastic, or secondary to trauma. Congenital TEF or bronchoesophageal fistula is usually associated with esophageal atresia and is readily diagnosed in infancy. But if it is not associated with esophageal atresia, it may persist until adulthood. Some theories have been proposed to explain this delay in diagnosis. We present a case of a 70-year-old man with congenital TEF. The TEF was successfully diagnosed by multidetector-row CT esophagography.

Primary esophageal diffuse large B cell lymphoma presenting with tracheoesophageal fistula: A rare case and review

Primary non-Hodgkin lymphomas in the esophagus are rare. Tracheoesophageal fistulas mainly arise from solid esophageal carcinoma or mediastinal malignancies. Our patient presented with cough, dysphagia and weight loss, and upon initial computed tomography imaging and esophagogastroduodenoscopy, a malignant mass in the middle third of esophagus with tracheoesophageal fistula was found. The location of the mass and presence of malignant tracheoesophageal fistula were strongly suggestive of squamous cell carcinoma. However, tumor biopsy revealed diffuse large B-cell lymphoma. This case report details a rare incident of a primary diffuse large B-cell lymphoma presented as tracheoesophageal fistula and reviews previous literature.

Early Morbidity and Perioperative Course of Neonates with Esophageal Atresia and Tracheoesophageal Fistula in a Tertiary Pediatric Surgical Center

Background: The management of infants (infs.) with esophageal atresia and tracheoesophageal fistula (EA ± TEF) is demanding and complex. The aim of this study was to evaluate early morbidity, the timing of surgery, and the results of surgery. Patients and Method: We collected data of 30 consecutive infs. treated for EA ± TEF between 2006 and 2014. Results: The median gestational age was 38 weeks (12 preterm), and the median Birth Weight (BW) was 2660 g (4 infs. had a BW 1500 g). The median Apgar score at 10 minutes was 10 (range 7 - 10). The median umbilical artery pH (UapH) was 7.30. According to the Spitz classification, 19 infs. were group 1, 9 infs. were group 2, and 2 infs. were group 3. Surgical repair was performed in 29 cases (25 EA;4 isolated TEF). Once the infs. arrived at the pediatric surgery department, surgery was postponed overnight in 11 cases. The duration of postoperative (p.o.) mechanical ventilation was significantly shorter for operations performed on day 2 after delivery. Twenty-four infs. (83%) underwent surgery within 2 days after delivery, and 5 infs. had later surgery. Chest drains (p.o.) for pneumothorax were inserted in 6 infs. (21%), and gastrostomy was performed in 6 cases (21%). No re-thoracotomy was required. The median length of hospital stay was 17.5 days (6 to 120). The incidence of p.o. mortality was 1 in 29 (3%). Discussion: The majority of the infs. presented growth retardation (indicated by low birth weight) and a stable immediate postnatal course. The data from this study support the concept of early but not emergent surgery for the majority of infs. with EA ± TEF. However, a remarkable rate of perioperative morbidity must be taken into account. Conclusion: Surgery for EA ± TEF can be performed safely during the first postnatal days with exception of very unstable preterm infants.

Accidental esophageal intubation via a large type C congenital tracheoesophageal fistula:A case report

BACKGROUND Tracheoesophageal fistula(TEF)is a congenital anomaly characterized by interruptions in esophageal continuity with or without fistulous communication to the trachea.Anesthetic management during TEF repair is challenging because of the difficulty of perioperative airway management.It is important to determine the appropriate position of the endotracheal tube(ETT)for proper ventilation and to prevent excessive gastric dilatation.Therefore,the tip of the ETT should be placed immediately below the fistula and above the carina.CASE SUMMARY A full-term,one-day-old,2.4 kg,50 cm male neonate was diagnosed with TEF type C.During induction,an ETT was inserted using video laryngoscope and advanced deeply to ensure that the tip passed over the fistula,according to known strategies.The passage of the ETT through the vocal cords was confirmed via video laryngoscope.However,after inflating the ETT cuff,breath sounds were not heard on bilateral lung auscultation.Instead,gastric sounds were heard.Considering that a large fistula(approximately 6.60 mm×4.54 mm)located 10.2mm above the carina was confirmed on preoperative tracheal computed tomography,the possibility of unintentional esophageal intubation was highly suspected.Therefore,we decided to uncuff and withdraw the ETT carefully for repositioning,while monitoring auscultation and end-tidal CO2 simultaneously.At a certain point(9.5 cm from the lip),clear breath sounds and proper end-tidal CO_(2) readings were suddenly achieved,and adequate ventilation was possible.CONCLUSION Preanesthetic anatomical evaluation with imaging studies in TEF is necessary to minimize complications related to airway management.

Double tracheal stents reduce side effects of progression of malignant tracheoesophageal fistula treated with immunotherapy: A case report

BACKGROUND The protective effect of tracheal stents is reported to relieve airway obstruction and reduce side effects of rapid progression of malignant tracheoesophageal fistula(MTEF)after immunotherapy in this case with 10 mo follow-up.CASE SUMMARY Two kinds of silicone stents were placed in the main airway of a 58-year-old male to relieve the airway obstruction caused by advanced esophageal carcinoma.The patient then received four doses of toripalimab.Subsequently,rapid,progressive deterioration of the original fistula was found.Although the fistula enlarged rapidly after immunotherapy,it remained covered completely,and likely because of this,his condition remained stable.Therefore,immunotherapy could be continued to treat the primary tumor.Despite these efforts,the patient died of the advancement of his esophageal cancer.CONCLUSION Appropriately-sized tracheal stent placement combined with immune checkpoint inhibitors may improve the quality of life and survival of patients with MTEF.

Local random flaps for cervical circumferential defect or tracheoesophageal fistula reconstruction after failed gastric pull-up: Two case reports

BACKGROUND Total pharyngo-laryngo-esophagectomy with a reconstruction of gastric pull-up is the most common treatment method for patients with multiple primary upper digestive tract carcinomas,such as hypopharyngeal carcinoma with thoracic esophageal carcinoma.However,neck circumferential defect and tracheoesophageal fistula after gastric necrosis are still challenging problems for surgeons and patients.CASE SUMMARY This case report presents 2 patients who underwent reconstructive surgeries using 4 local random flaps with a split thickness skin graft in the first case,and 6 local random flaps in the second case to close the circumferential defect and tracheoesophageal fistula after failed gastric pull-up.Both patients achieved good swallowing function and could take solid diet without dysphagia postoperatively.CONCLUSION For selected patients,local random flaps(with a split thickness skin graft)can be a simple and reliable solution for reconstructing tracheoesophageal fistula or cervical circumferential defect after gastric necrosis,especially when the necrosis extends below the thoracic inlet.

Tracheoesophageal fistulas in coronavirus disease 2019 pandemic:A case report

BACKGROUND Tracheoesophageal fistulas(TEFs)can be described as a pathological communication between the trachea and the esophagus.According to their origin,they may be classified as benign or malignant.Benign TEFs occur mostly as a consequence of prolonged mechanical ventilation,particularly among patients exposed to endotracheal cuff overinflation.During the severe acute respiratory syndrome coronavirus 2 virus pandemic,the amount of patients requiring prolonged ventilation rose,which in turn increased the incidence of TEFs.CASE SUMMARY We report the cases of 14 patients with different comorbidities such as being overweight,or having been diagnosed with diabetes mellitus or systemic hypertension.The most common symptoms on arrival were dyspnea and cough.In all cases,the diagnosis of TEFs was made through upper endoscopy.Depending on the location and size of each fistula,either endoscopic or surgical treatment was provided.Eight patients were treated endoscopically.Successful closure of the defect was achieved through over the scope clips in two patients,while three of them required endoscopic metal stenting.A hemoclip was used to successfully treat one patient,and it was used temporarily for another patient pended surgery.Surgical treatment was performed in patients with failed endoscopic management,leading to successful defect correction.Two patients died before receiving corrective treatment and four died later on in their clinical course due to infectious complications.CONCLUSION The incidence of TEFs increased during the coronavirus disease 2019 pandemic(from 0.5%to 1.5%).We believe that endoscopic treatment should be considered as an option for this group of patients,since evidence reported in the literature is still a growing area.Therefore,we propose an algorithm to lead intervention in patients presenting with TEFs due to prolonged intubation.

Diagnose and treatment for Type D congenital esophageal atresia with tracheoesophageal fistula

Importance:Type D esophageal atresia(EA)with tracheoesophageal fistula(TEF)is characterized by EA with both proximal and distal TEFs.It is a rare congenital anomaly with a very low incidence.Objective:To investigate diagnostic and treatment strategies for this rare condition.Methods:We retrospectively reviewed the clinicopathological features of patients with EA/TEF treated at our institution between January 2007 and September 2021.Results:Among 386 patients with EA/TEF,14(3.6%)had type D EA/TEF.Only two patients were diagnosed with proximal TEF preoperatively.Seven patients were diagnosed intraoperatively.Five patients were missed for diagnosis during the initial surgery but was later confirmed by bronchoscopy.During the neonatal period,seven patients underwent a one-stage repair of proximal and distal TEF via thoracoscopy or thoracotomy.Due to missed diagnosis and other reasons,the other 7 patients underwent two-stage surgery for repair of the proximal TEF,including cervical incision and thoracoscopy.Ten of the 14 patients experienced postoperative complications including anastomotic leakage,pneumothorax,esophageal stricture,and recurrence.Patients who underwent one-stage repair of distal and proximal TEF during the neonatal period showed a higher incidence of anastomotic leak(4/7).In contrast,only one of seven patients with two-stage repair of the proximal TEF developed an anastomotic leak.Interpretation:Type D EA/TEF is a rare condition,and proximal TEFs are easily missed.Bronchoscopy may aim to diagnose and determine the correct surgical approach.A cervical approach may be more suitable for repairing the proximal TEF.

Comparison of neonatal tolerance to thoracoscopic and open repair of esophageal atresia with tracheoesophageal fistula

Background Advances in minimally invasive surgical techniques and neonatal intensive care for neonates have allowed for repair of the neonatal esophageal atresia with tracheoesophageal fistula （EA/TEF） to be approached endoscopically. However, thoracoscopic surgery in children is still performed in only a few centers throughout the world. The aim of this study was to compare the neonatal tolerance to the thoracoscopic repair （TR） and the open repair （OR） and also to discuss anesthetic management in thoracoscopic procedure. Methods We performed a prospective study enrolling newborns diagnosed with EA with distal TEF （type C） receiving the repair surgery between June 2009 and January 2012 in our institution. Data collected included the newborns＇ gestational age and weight at the time of the operation, operative time, parameters of intraoperative mechanical ventilation, oxygenation, end-tidal carbon dioxide （ETCO2）, and analysis of blood gases. Time to extubation and length of stay were also recorded. Results Intravenous induction with muscle paralysis followed by pressure-control ventilation and tracheal intubation regardless of the position of the fistula can be performed uneventfully in EA/TEF newborns with no additional airway anomalies and large, pericarinal fistulas in our experiences. The thoracoscopic approach appeared to take longer than the open approach. During the procedure of repair, hypercarbia and acidosis developed immediately 1 hour after pneumothorax in both groups. CO2 insufflation did have additional influence on the respiratory function of the newborns in the TR group; values of PaCO2 and ETCO2 were higher in the TR group but the difference did not reach statistical significance. By the end of the procedure, values of PaCO2 and ETCO2 returned to the baseline levels while pH did not, but all parameters made no difference in the two groups. Besides, time to extubation was shorter in the TR group. Conclusions Thoracoscopic repair of EA/TEF is comparable to the open repair, and is believed to be safe and tolerable in selected patients. A wider range of neonates may be acceptable for thoracoscopic EA/TEF repair with increasinQ surQical experience.

Long-term esophageal and respiratory outcomes in children with esophageal atresia and tracheoesophageal fistula

Objectives:Few studies have evaluated the long-term complications and outcomes of esophageal atresia with or without tracheoesophageal fistula(EA/TEF)beyond childhood.The aim of our study was to characterize the esophageal and respiratory morbidity of EA/TEF through evaluation of clinical symptoms,diagnostic testing and therapeutic intervention at a tertiary care center.Methods:Patients with congenital EA/TEF evaluated from 2011 to 2014 were included.Demographic characteristics,type and mode of repair of EA/TEF,clinical symptoms,radiographic,endoscopic,bronchoscopic and medication use data were obtained.Results:A total of 43 patients were identified.The median age of this predominantly Caucasian population was 8 years(interquartile range:3,20).Twenty(62.5%)had type C(EA with distal TEF)abnormality.Twenty-one(48.8%)patients had heartburn,19(44.1%)had acid regurgitation,and 31(72.1%)had dysphagia to solids.Barium swallow in 26 patients revealed strictures in 17(65.4%),dysmotility in 20(76.9%)and recurrent fistulas in four patients(15.4%).Thirty patients underwent upper endoscopy,of which 21(70.0%)had a stricture,and six(20.0%)had recurrent fistula requiring surgical intervention.Eight(18.6%)patients underwent fundoplication.Pulmonary evaluation showed cough and choking in 31(72.1%)patients and dyspnea and wheezing in 32(53.4%)patients.Recurrent respiratory infections were reported in 19(44.2%).patients.Other findings included tracheomalacia in 86.7% and restrictive lung disease in 54.5%of patients.Conclusion:There is a high burden of residual esophageal and pulmonary pathology in patients with EA/TEF.Ongoing follow-up is required to monitor both the clinical symptoms and treatment responses.

Acupuncture for dysphagia after surgery for Esophageal Atresia with tracheoesophageal fistula:A case report

A 5-month plus 2-week-old male infant underwent esophageal atresia(EA)with tracheoesophageal fistula(TEF)repair,dysphagia gradually aggravated after EA repair,the patient occurred frequent choke and cough,vomiting aroused in the case of eating a little faster,anorexia and impatience were manifested.Based on the history of preterm birth,clinical symptoms and signs,chest CT,and barium swallow radiography of digestive tract,the patient was clearly diagnosed with EA/TEF(IIIA).Dysphagia soon followed after thoracoscopic surgery,he was diagnosed as dysphagia.Acupuncture was applied at bilateral Fēngchí(风池GB20),Liánquán(廉泉CV23),Tiāntū(天突CV 22),Zhōngwǎn(中脘CV12)and bilateral Zúsānlí(足三里ST36).The needles were retained for 20 min per session,treatments were scheduled on Monday,Wednesday and Friday of each week,three times a week,the duration was 4 weeks.After acupuncture treatment,the patient basically had no choke,cough,anorexia and impatience.The total time of food intake was significantly shortened than before.Except for special food restrictions,the modified functional oral intake scale was evaluated as level 6.Acupuncture might be a beneficial option for the treatment of complications after EA repair.

Primary repair of esophageal atresia Gross type C via thoracoscopic magnetic compression anastomosis:Is it the best option?

Magnetic compression anastomosis is a promising treatment option for patients with complex esophageal atresia;but,at the present time,should not be the first therapeutic option in those cases where the surgeon can perform a primary anastomosis of the two ends of the esophagus with acceptable tension.

Passage of nasogastric tube through tracheo-esophageal fistula into stomach: A rare event

Esophageal atresia with tracheo-oesophageal fistula(TEF) occurs in 1 in 3500 live births. Anorectal malformation is found to be associated with 14% of TEF. Esophageal atresia with TEF is a congenital anomaly which classically presents as excessive frothing from the mouth and respiratory distress. Rarely gastric position of the feeding tube in a case of TEF can be obtained delaying the diagnosis of TEF. We had an uncommon situation where a nasogastric tube reached the stomach through the trachea and tracheo-esophageal fistula, leading to misdiagnosis in a case of esophageal atresia with tracheoesophageal fistula. By using a stiff rubber catheter instead of a soft feeding tube for the diagnosis of esophageal atresia and TEF, such situation can be avoided.

Cardiac arrest due to massive aspiration from a broncho-esophageal fistula: A case report

BACKGROUND Tracheo and broncho esophageal fistulas and their potential complications in adults are seldom encountered in clinical practice but carries a significant morbidity and mortality.CASE SUMMARY We present a case of a 39-year-old otherwise healthy man who presented to our hospital after ingestion of drain cleaner substance during a suicidal attempt.He unexpectedly suffered from cardiac arrest during his stay in the intensive care unit.The patient had developed extensive segmental trachea-broncho-esophageal fistulous tracks that led to a sudden and significant aspiration event of gastric and duodenal contents with subsequent cardiopulmonary arrest.Endoscopic evaluation of extension of fistulous track proved a slow and delayed progression of disease despite initial management with esophageal stenting for his caustic injury.CONCLUSION The aim of this case presentation is to share with the reader the dire natural history of trachea-broncho-esophageal fistulas and its delayed progression.We aim to illustrate pitfalls in the endoscopic examination and provide further aware-ness on critical care monitoring and management strategies to reduce its morbidity and mortality.

Endoscopic Detection and Surgical Repair of Congenital Tracheo-Esophageal-Fistula(TEF)±Esophageal Atresia(EA)

Purpose: This study was performed to evaluate the management of tracheoesophageal fistula (TEF) ± esophageal atresia (EA) under the guidance of preoperative tracheo-bronchoscopy (TrSc). Methods: Between 2007 and July 2014, a total of 26 consecutive newborns who underwent rigid TrSc for suspected TEF were identified. All associated charts and operation reports were retrospectively analyzed. Results: Distal TEF with EA (Gross C) predominated (n = 18). Furthermore, we managed 2 infants with proximal and distal TEF (Gross D) and 4 infants with isolated TEF (Gross E). In our hands, TrSc was feasible in infants with a birth weight above 1300 g. Twenty-five fistulas were identified by endoscopy in 23 patients. In one infant with a birth weight below 1000 g, an attempt to perform TrSc was interrupted, and urgent TEF closure was required. Fistula site at the carina was associated with a high rate of esophageal anastomosis under tension. During surgery, proximal TEF and isolated TEF were safely approached via right cervicotomy (n =5). Conclusion: This study supports the routine use of rigid TrSc at the time of surgery. Rigid TrSc allowed the surgical team to identify the number and location of TEFs, and the incidence of side effects was low.

Current knowledge on esophageal atresia

Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is the most common congenital anomaly of the esophagus. The improvement of survival observed over the previous two decades is multifactorial and largely attributable to advances in neonatal intensive care, neonatal anesthesia, ventilatory and nutritional support, antibiotics, early surgical intervention, surgical materials and techniques. Indeed, mortality is currently limited to those cases with coexisting severe life-threatening anomalies. The diagnosis of EA is most commonly made during the first 24 h of life but may occur either antenatally or may be delayed. The primary surgical correction for EA and TEF is the best option in the absence of severe malformations. There is no ideal replacement for the esophagus and the optimal surgical treatment for patients with long-gap EA is still contro-versial. The primary complications during the postoperative period are leak and stenosis of the anastomosis, gastro-esophageal reflux, esophageal dysmotility, fistula recurrence, respiratory disorders and deformities of the thoracic wall. Data regarding long-term outcomes and follow-ups are limited for patients following EA/TEF repair. The determination of the risk factors for the complicated evolution following EA/TEF repair may positively impact long-term prognoses. Much remains to be studied regarding this condition. This manuscript provides a literature review of the current knowledge regarding EA.

Application of MPVR and TL-VR with 64-row MDCT in neonates with congenital EA and distal TEF

AIM:To assess the application of multiple planar volume reconstruction(MPVR) and three-dimensional (3D) transparency lung volume rendering(TL-VR) with 64-row multidetector-row computed tomography (MDCT) in neonates with congenital esophageal atresia (EA) and distal tracheoesophageal fistula(TEF).METHODS:Twenty neonates(17 boys,3 girls) with EA and distal TEF at a mean age of 4.6 d(range 1-16 d) were enrolled in this study.A helical scan of 64-row MDCT was performed at the 64 mm×0.625 mm collimation.EA and TEF were reconstructed with MPVR and TL-VR,respectively.Initial diagnosis of EA was made by chest radiography showing the inserted catheter in the proximal blind-ended esophageal pouch.Manifestations of MDCT images were compared with the findings at surgery.RESULTS:MDCT showed the proximal and distal esophageal pouches in 20 cases.No significant difference was observed in gaps between the proximal and distal esophageal pouches detected by MPVR and TLVR.The lengths of gaps between the proximal and distal esophageal pouches detected by MPVR and TL-VR correlated well with the findings at surgery(R=0.87,P<0.001).The images of MPVR revealed the orifice of TEF in 13 cases,while TL-VR images showed the orifice of TEF in 4 cases.CONCLUSION:EA and distal TEF can be reconstructed using MPVR and TL-VR of 64-row MDCT,which is a noninvasive technique to demonstrate the distal esophageal pouches and inter-pouch distance in neonates with EA and distal TEF.