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• What is currently known about this topic? • Esophageal pulmonary fistula is a special type complication that occurs after esophageal atresia/tracheoesophageal fistula repair, which is also classified as acquired tracheoesophageal fistula by some scholars. • What new information is contained in this article? • We described the characteristics esophageal pulmonary fistula and carried out thoracoscopic surgery firstly with satisfactory results in a short follow-up time. Esophageal pulmonary fistula is a special type of acquired tracheoesophageal fistula that occurs after esophageal atresia/tracheoesophageal fistula repair. Thoracotomy is the surgical repair method currently in use, but postoperative outcomes are unclear. Therefore, we aimed to explore the preliminary safety, effectiveness, and feasibility of thoracoscopic surgical repair of esophageal pulmonary fistula. We retrospectively collected data from all patients with esophageal atresia/tracheoesophageal fistula at Beijing Children's Hospital from January 2017 to October 2021, and the clinical characteristics of patients with esophageal pulmonary fistula were analyzed. Clinical information was recorded, and follow-up was performed. Seven patients (five boys and two girls) were diagnosed as esophageal pulmonary fistula. All patients underwent multiple esophageal surgeries and had esophageal strictures before surgical repair. Clinical manifestations included cough, expectoration, and recurrent pneumonia. Esophagography indicated the location of the fistula with a 100% positive rate, while the positive rate of flexible bronchoscopy and chest computed tomography was 57% (4/7) and 43% (3/7), respectively. Surgical repair was achieved using thoracoscopy with an average operation time of 172 min. All patients developed esophageal strictures, four of which had refractory esophageal strictures and underwent esophageal dilations ranged from 5 to 56 times before this surgery, but anastomotic leakage or acquired esophageal pulmonary fistulas were absent post-surgery. After a median follow-up of 22 months, all patients survived, and the symptoms were well controlled. Esophageal pulmonary fistula is a rare complication of atresia/tracheoesophageal fistula repair. Thoracoscopic surgery is still possible even after previous multiple surgeries in the chest with significant complications and satisfactory results can be achieved in the short term. Level III [ABSTRACT FROM AUTHOR]

Copyright of Revista Colombiana de Gastroenterología is the property of Asociacion Colombiana de Gastroenterologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cukurova Medical Journal / Çukurova Üniversitesi Tip Fakültesi Dergisi is the property of Cukurova University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We described a case of a 30-year-old Filipino woman who presented with fevers, night sweats, left hip pain, painful scalp lesions, and a neck mass. Symptoms began 6 months earlier, with nasal drainage, fever, cough, and occasional hemoptysis, which did not resolve with outpatient antibiotics. A further workup revealed lymphadenopathy and several lytic bone lesions. Her hospital course was later further complicated by the development of a tracheoesophageal fistula secondary to an esophageal mass and, then later, aseptic meningitis. Extensive diagnostic workup and immunologic tests were performed and finally led to the diagnosis. Here, we discussed the diagnostic workup and pathophysiology of the underlying condition. This case illustrated the importance of appropriate immunologic workup to make the diagnosis of a rare condition that proves to be clinically significant and presents challenges in management. [ABSTRACT FROM AUTHOR]

Most of the research in the field of esophageal atresia (EA) is focused on diagnostic problems and surgery. There is scarce literature addressing the impact of EA on the lives of families of patients. The aim of this paper is to investigate whether the presence of underlying associated malformations, disease-specific feeding problems and prematurity would have a significant influence on the family of a child after surgical repair of EA. The study sample consisted of 73 participants who were parents of children after surgery of EA. The impact of EA on families was assessed using an Authors-Designed Questionnaire (ADQ) to collect medical and sociodemographic background data as well as standardized questionnaire: the PedsQL™ Family Impact Module (PedsQL-FIM). The presence of cardiac impairment significantly (p = 0.037) affects the functioning of the family in the emotional domain. The coexistence of skeletal impairment seems to have the greatest impact on the functioning of the family, three statistically significant correlations have been demonstrated: (p = 0.021) - in the social domain, (p = 0.009) - in the cognitive domain and (p = 0.023) - in the domain of communication. The families of patients with tracheoesophageal fistula (TEF) had the statistically lower (p < 0.05) score of functioning in the emotional domain than those with children without TEF. Feeding problems and the presence of associated anomalies significantly affect the functioning of the family of the child with EA. • Children with developmental defects often require long-term and multidirectional medical care. • Congenital esophageal atresia significantly affects the functioning of the family. • A child centered perspective is important to nurses who care for children after esophageal atresia repair. [ABSTRACT FROM AUTHOR]

Background: The posterior left atrium is an arrhythmogenic substrate that contributes to the initiation and maintenance of atrial fibrillation (AF); however, the feasibility, safety, and efficacy of posterior wall isolation (PWI) as an AF ablation strategy has not been widely reported.Methods: We undertook a systematic review and meta-analysis of studies performing PWI to assess (1) acute procedural success including the ability to achieve PWI and the number of procedure-related complications, (2) Long-term, clinical success including rates of arrhythmia recurrence and posterior wall reconnection, and (3) The efficacy of PWI compared with pulmonary vein isolation on preventing arrhythmia recurrence. MEDLINE, EMBASE, and Web of Science databases were searched in May 2018 to retrieve relevant studies. Results were pooled using a random effects model.Results: Seventeen studies (13 box isolation, 3 single ring isolation, and 1 debulking ablation) comprising 1643 patients (31.3% paroxysmal AF, left atrial diameter 41±3.1 mm) were included in the final analysis. In studies focusing specifically on PWI, the acute procedural success rate for achieving PWI was 94.1% (95% CI, 87.2%-99.3%). Single-procedure 12-month freedom from atrial arrhythmia was 65.3% (95% CI, 57.7%-73.9%) overall and 61.9% (54.2%-70.8%) for persistent AF. Randomized control trials comparing PWI to pulmonary vein isolation (3 studies, 444 patients) yielded conflicting results and could not confirm an incremental benefit to PWI. Fifteen major complications (0.1%), including 2 atrio-esophageal fistulas, were reported.Conclusions: PWI as an end point of AF ablation can be achieved in a large proportion of cases with good rates of 12-month freedom from atrial arrhythmia. Although the procedure-related complication rate is low, it did not eliminate the risk of atrio-esophageal fistula. Registration: URL: http://www.crd.york.ac.uk/prospero. PROSPERO registration number: CRD42018107212. [ABSTRACT FROM AUTHOR]

The article describes the case of a middle aged woman with a history of achalasia and chronic back pain who presented with postthoracic spinal cord stimulator placement. Topics covered include the findings of esophageal manometry and esophagram which led to the diagnosis of dysphagia, patient outcome after minimally invasive esophageal peroral endoscopic myotomy (POEM) procedure, and the effectiveness of esophagogastrostomy in the treatment of dysphagia that relapsed several years later.

Heterotopic gastric mucosa (HGM) is occasionally found at endoscopy in the proximal esophagus of adults and children, when it manifests as an asymptomatic small island of reddish pink mucosa just below the upper esophageal sphincter. There are few reports of esophageal HGM detected by endoscopy after repair of esophageal atresia (EA) with tracheo-esophageal fistula (TEF). We report a child with multiple patches of HGM in the proximal and distal esophagus seen at endoscopy after EA/TEF repair. No obvious symptoms were related to the HGM and she remains under endoscopic surveillance. The incidence of esophageal HGM may be increased in patients with EA and its distribution can be more extensive than a simple “inlet patch”. There is evidence to suggest that esophageal HGM increases the risk of developing Barrett's esophagus and has a malignant potential. Heterotopic gastric mucosa extends the spectrum of potential pathologies affecting the esophagus in patients with EA/TEF and supports current international guidelines for endoscopic surveillance of these patients. [ABSTRACT FROM AUTHOR]

Background: Percutaneous or surgical ablation are increasingly used worldwide in the management of atrial fibrillation. The development of atrioesophageal fistula (AEF) is among the most serious and lethal complications of atrial fibrillation ablation. We sought to characterize the clinical presentation, procedural characteristics, diagnostic investigations, and treatment outcomes of all reported cases of AEF.Methods and Results: Electronic searches were conducted in PubMed and Embase for English scientific literature articles. Out of 628 references, 120 cases of AEF were identified using various ablation modalities. Clinical presentation occurred between 0 and 60 days postablation (median 21 days). Fever (73%), neurological (72%), gastrointestinal (41%), and cardiac (40%) symptoms were the commonest presentations. Computed tomography of the chest was the commonest mode of diagnosis (68%), although 7 cases required repeat testing. Overall mortality was 55%, with significantly reduced mortality in patients undergoing surgical repair (33%) compared with endoscopic treatment (65%) and conservative management (97%) (adjusted odds ratio, 24.9; P<0.01, compared with surgery). Multivariable predictors of mortality include presentation with neurological symptoms (adjusted odds ratio, 16.0; P<0.001) and gastrointestinal bleed (adjusted odds ratio, 4.2; P=0.047).Conclusions: AEF complicating atrial fibrillation ablation is associated with a high mortality. Clinicians should have a high suspicion for the development of AEF in patients presenting with infective, neurological, gastrointestinal, or cardiac symptoms within 2 months of an atrial fibrillation ablation. Investigation by contrast computed tomography of the chest with consideration of repeat testing can lead to prompt diagnosis. Surgical intervention is associated with improved survival rates. [ABSTRACT FROM AUTHOR]

Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) are relatively common congenital anomalies. Additional variants of these anomalies have been reported, including EA-TEF associated with congenital esophageal stenosis (CES) and a few reports of EA-TEF associated with an esophageal web or membranous diaphragm. We report an extremely rare case of EA with distal TEF associated with both a CES and a separate esophageal web distal to the TEF. EA-TEF with an associated CES and/or mucosal web distal to the TEF presents both a diagnostic and management challenge, as the standard diagnostic/pre-operative work-up may not identify the distal areas of esophageal occlusion. Surgeons should be aware and should maintain a high index of suspicion for these anatomic variants as they can lead to operative complications. Use of a tube to confirm patency of the distal esophageal pouch as a standard technique during EA-TEF repair may help avoid the potential pitfalls associated with failure to recognize these conditions. [ABSTRACT FROM AUTHOR]

Congenital esophageal stenosis (CES) is rare condition found in 1 per 25,000 to 50,000 live births. It is characterized by intrinsic narrowing of the esophagus secondary to congenital malformation of the esophageal wall architecture. Diagnosis is often difficult to definitively establish as the symptoms are often initially attributed to esophageal strictures secondary to reflux, or occur within the context of a tracheo-esophageal fistula (TEF) in the newborn. Endoscopic dilation and surgical repair are the mainstays of treatment. We report a series of three cases seen recently at our institution, the University of Alberta/Stollery Children's Hospital. [ABSTRACT FROM AUTHOR]

Background: Up to 40% of patients demonstrate endoscopically detected asymptomatic esophageal lesions (EDEL) after atrial fibrillation ablation.Methods and Results: Patients undergoing first atrial fibrillation ablation and postinterventional esophageal endoscopy were included in the study. Occurrence of esophageal perforating complications during follow-up was related to documented EDEL (category 1: erythema/erosion; category 2: ulcer). In total, 1802 patients underwent first atrial fibrillation ablation procedure between January 2013 and August 2016 at our institution. Out of this group, 832 patients (506 male patients, 61%; 64.0±10.0 years) with symptomatic paroxysmal (n=345; 42%) or persistent atrial fibrillation underwent postprocedural esophageal endoscopy. Patients were ablated using single-tip ablation with conventional or surround flow irrigation and circular ablation catheters with open irrigation (nMARQ). In 295 of 832 patients (35%), a temperature probe was used. EDEL occurred in 150 patients (18%; n=98 category 1 EDEL, n=52 category 2 EDEL). In 5 of 832 patients (0.6%), an esophageal perforation (n=3) or an esophagopericardial or atrioesophageal fistula (n=2) occurred 15 to 28 days (19±6 days) after ablation. Two patients (1 atrioesophageal fistula and 1 esophagopericardial fistula) died. Esophageal perforation occurred only in patients with category 2 lesions (absolute risk, 9.6%). In a logistic regression analysis, ulcers were identified to be a significant predictor for esophageal perforating complications.Conclusions: Postablation endoscopy seems to identify patients at high risk of esophageal perforating complications only occurring in patients with category 2 EDEL. One out of 10 postablation esophageal ulcers progressed to perforation, and no patient without esophageal thermal ulcers showed the occurrence of perforating esophageal complications. [ABSTRACT FROM AUTHOR]

Background: Anastomotic leakage following esophageal surgery is a major contributor to mortality. According to the national database leakage occurs in 20% of esophagectomies carried out in the Netherlands. Therefore anastomotic leakage has been the topic of many studies. However, studies discussing application of tissue adhesives for either prevention or management of anastomotic leakage are limited. This article systematically reviewed all available literature on the potential use of tissue adhesives in esophageal surgery.Methods: Medline, Embase and Cochrane were searched to identify studies that used tissue adhesives as anastomotic sealants to prevent esophageal anastomotic leakage or used tissue adhesives to treat esophageal anastomotic leakage. Two authors independently selected nineteen out of 3107 articles.Results: Eight articles, of which five were experimental and three clinical, discussed prevention of anastomotic leakage. Eleven articles, of which one was experimental and ten clinical, discussed treatment of anastomotic leakage. Most articles reported positive results, however overall quality was low due to a high degree of bias and lack of homogeneity.Conclusion: This study shows mainly positive results for the use of tissue adhesives for the esophageal anastomosis both in prevention of leakage as treating anastomotic leakage. However, the quality of current literature is poor. [ABSTRACT FROM AUTHOR]

Background: Esophageal atresia is a major anomaly of varying severity. The complexity of surgical correction depends on the presence of a distal fistula.Objective: This study aimed to determine the feasibility and accuracy of prenatal ultrasound detection of the distal fistula in fetuses diagnosed with esophageal atresia.Study Design: This was an observational study conducted at a single tertiary care center between 2019 and 2021. Included were pregnant patients carrying a fetus prenatally diagnosed with esophageal atresia that was confirmed postnatally during corrective surgery or at postmortem autopsy. During the scan, the performing investigator determined the presence or absence of a distal fistula by scanning the location of the lower esophagus during fetal breathing. Cases in which the lower esophagus was observed distending with amniotic fluid during breathing were deemed "fistula present," and the remaining cases "fistula absent." Test feasibility and performance indices, including sensitivity, specificity, and positive and negative predictive value were calculated. The offline clips and images were reviewed by 2 investigators for the assessment of interoperator agreement using Cohen's Kappa formula.Results: Included were 16 fetuses with esophageal atresia scanned between 2019 and 2021. All fetuses were successfully scanned with sufficient resolution of the area of interest during at least 3 cycles of breathing. It took a median of 8.5 minutes to determine the presence or absence of a distal fistula. The feasibility of the test was 100% (16/16). The test's sensitivity, specificity, and positive and negative predictive values were 80% (95% confidence interval, 55-100), 100% (95% confidence interval, 60-100), 100% (95% confidence interval, 65-100), and 75% (95% confidence interval, 45-100), respectively. The Cohen's Kappa for interoperator agreement was calculated to be 1, P<.001, corresponding to a "perfect" level of agreement.Conclusion: Distal fistulas in esophageal atresia can be demonstrated prenatally by targeted scanning using appropriate technique. The method provided is feasible, reproducible, and has excellent performance indices. This novel technique and observations may improve the prenatal diagnosis and counseling of esophageal atresia. [ABSTRACT FROM AUTHOR]

Injuries related to button battery ingestion have become increasingly common in children. Recognition of battery ingestion is often delayed and thus leads to serious esophageal injury. Resultant distal acquired tracheoesophageal fistulas are difficult to safely access and repair. Herein, we report the multidisciplinary repair of a distal tracheoesophageal injury, secondary to battery ingestion, via an innovative trans-cervical surgical approach. [ABSTRACT FROM AUTHOR]

Complications subsequent to repair of a congenital tracheoesophageal fistula (TEF) with esophageal atresia (EA) include leak at the anastomosis, stricture formation, and recurrent fistula. Recurrence is uncommon, and the optimal management for a recurrent fistula is debatable. As many of the symptoms of TEF recurrence are similar to common postoperative sequelae, diagnosis of these recurrences can be quite challenging. We report the case of a 12 year old patient with a history of Type B EA/TEF (proximal pouch fistula, distal atresia) who was discovered to have a TEF recurrence over a decade after his initial repair which was successfully treated with cautery ablation of the fistula tract. [ABSTRACT FROM AUTHOR]

Copyright of Cukurova Medical Journal / Çukurova Üniversitesi Tip Fakültesi Dergisi is the property of Cukurova University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Esophageal atresia is a congenital pathology in 1:4000 live newborns, which can occur isolated, associated with tracheoesophageal fistula or long gap (>2 vertebral bodies); the surgical objective is the ligation of the fistula and the esophageal anastomosis in the same surgery. However, this may not be possible in all cases [1]. The staged approach initially begins with the ligation of the tracheoesophageal fistula and gastrostomy, and definitive surgery focuses on the esophageal anastomosis. It is performed when the patient presents adequate clinical and anatomical conditions. Spontaneous recanalization of esophageal atresia is rare. The exact mechanism by which it occurs is unknown. Gastric reflux, being in contact with the esophageal distal end, generates inflammation and erosion of the wall, producing communication between the esophageal segments. We propose approximating the proximal and distal esophageal segments utilizing sutures produces an inflammatory process due to a foreign body generating a fistulous tract between the two esophageal components and esophageal recanalization [2]. We present two cases of esophageal recanalization to describe the clinical presentation, diagnostic and therapeutic approaches through imaging tests and endoscopy, contributing to the management of this unusual condition. • Esophageal atresia is a challenge; it presents variations in the location of the tracheoesophageal fistula and the length of the esophageal ends. It occurs isolated or associated with malformations. The pediatric surgeon must individualize treatment for each patient. • In all cases, extreme premature patients have hemodynamic alterations and fragile esophageal tissue, which do not allow performing a primary esophageal anastomosis. • Upper gastrointestinal endoscopy is a diagnostic and therapeutic resource in patients with spontaneous esophageal recanalization or the presence of a recurrent tracheoesophageal fistula. [ABSTRACT FROM AUTHOR]

A newborn with a vascular ring exhibiting a right-dominant double aortic arch (DAA), a left-side patent ductus arteriosus (PDA), and esophageal atresia with a tracheoesophageal fistula (TEF), was admitted to our neonatal intensive care unit. Although very rare, TEF and DAA may co-occur early in development. We recommend that, first, the fistula should be repaired and the esophageal anastomosis should be performed after division of the DAA. When an AA abnormality (including a DAA) is evident, the approach to the AA and the direction of the thoracotomy incision should be reversed to render surgery relatively easy. [ABSTRACT FROM AUTHOR]

Aberrant right subclavian artery (ARSA)-esophageal fistula has rarely been reported but has fatal outcomes in most cases. We report a 10-year-old girl who presented with massive hematemesis during recovery from a head injury caused by a motor vehicle accident. Prompt detection of the esophageal bleeding point by esophagoscopy followed by a balloon tamponade led to temporary hemostasis, during which time an emergency operation was prepared and started promptly. Two-staged surgery was performed with a successful outcome; direct vascular access to the right atrium and suturing of the bleeding point of ARSA through a T-shaped skin incision with median sternotomy were performed in the first surgery, and dividing the ARSA and repairing the esophagus were performed in the second surgery on the following day. Multidisciplinary treatment with pediatric intensivists, gastroenterologists, cardiovascular surgeons, and general surgeons is essential to address the near-fatal complication of ARSA in children. [ABSTRACT FROM AUTHOR]

Esophageal TB is a relatively uncommon condition. Mostly, the esophagus can be affected by tuberculosis through direct spread or from mediastinal nodes (rarely from the lungs or bloodstream). The most common symptom is dysphagia, and the diagnosis is confirmed by histology. If left untreated, esophageal tuberculosis can result in bleeding, perforation, fistula formation, aspiration pneumonia, lethal hematemesis, traction diverticula, and esophageal strictures. This is a rare case report of an esophageal fistula caused by tuberculosis in a patient presenting with a cough on eating and weight loss. The patient was subjected to upper gastrointestinal endoscopy, which revealed a cervical esophagus fistula 20 cm from the upper central incisors. Histopathology revealed inflammatory lesions with epithelioid granulomas (granulomatous disease). A mycobacterium sputum examination was performed; the smear was negative. The patient was managed conservatively with anti-tuberculosis treatment (ATT). A follow-up endoscopy after two months revealed that the fistula was closed and clinically improved. The quick clearance of contaminated sputum by coordinated peristalsis, paired with upright posture and an intact lower esophageal sphincter, limits the organism's exposure to the esophagus. Despite the disease's rarity, if not delayed, it can be efficiently managed with ATT to avoid major complications like esophageal perforation, which necessitates surgery. • Esophageal fistula due to complicated esophageal tuberculosis can be efficiently managed with ATT to avoid major complications like esophageal perforation, which necessitates surgery. • This case highlights non-surgical management of the esophageal fistula due to complicated esophageal tuberculosis. • Esophageal fistula is one of the rare clinical manifestations of esophageal tuberculosis, and the most common symptom is dysphagia. [ABSTRACT FROM AUTHOR]

Penetrating neck trauma are uncommon in the pediatric population, but they constitute a significant management challenge. An air shotgun remains a significant source of injury to children. It causes severe damage and can involve the brain, eyes, heart, abdomen, and other body parts. Penetrating neck wounds account for almost 20% of firearm-related injuries in children and adolescents. Esophagus injury happened 9.6% of children with non-intracranial firearm injury. A 3 -years-old boy referred from secondary level hospital by dr. Soetomo General Hospital with a history of accidently shot by an air shotgun at the neck area. Patient underwent two surgeries in a second level hospital. First surgery was removing the bullet. The second surgery was indicated due to complications of subcutis emphysema. Because the drain production was milk, the patient was referred to our hospital. We suspected there were a esophageal cutaneous fistula. Patient was admitted and managed conservatively with IV fluids, IV antibiotics, adequate wound care, and surgical nutritional care by gastrostomy feeding. After one week, the patient was discharged from hospital. Patient is having a diet from gastrostomy feeding and is scheduled to take esophagogram evaluation. Esophagus injury in penetrating neck trauma by air shotgun in pediatric is a rare case, the esophageal cutaneous fistula as complications is even rarer. We conclude that they can be successfully managed by an active nonoperative approach. A good antibiotic coverage, nutritional support, adequate wound care, limited surgical interventions like gastrostomy are vital and may be induced secondary healing to close the fistula. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: During radiofrequency catheter ablation for atrial fibrillation, the esophagus is at risk for thermal injury. In this study, C-arm computed tomography (CT) was compared to clinical CT, without the administration of oral contrast, to visualize the esophagus and its relationship to the left atrium and the ostia of the pulmonary veins (PVs) during the radiofrequency ablation procedure. Materials and Methods: Sixteen subjects underwent both cardiac clinical CT and C-arm CT. Computed tomographic scans were performed on a multidetector scanner using a standard electrocardiographically gated protocol. C-arm computed tomographic scans were obtained using either a multisweep protocol with retrospective electrocardiographic gating or a non-gated single-sweep protocol. C-arm and clinical computed tomographic scans were analyzed in a random order and then compared for the following criteria: (1) visualization of the esophagus (yes or no), (2) relationship of esophageal position to the four PVs, and (3) direct contact or absence of a fat pad between the esophagus and the PV antrum. Results: The esophagus was identified in all C-arm and clinical computed tomographic scans. In four cases, orthogonal planes were needed on C-arm CT (inferior PV level). In six patients, the esophageal location on C-arm CT was different from that on CT. Direct contact was reported in 19 of 64 of the segments (30%) examined on CT and in 26 of 64 (41%) on C-arm CT. In five of 64 segments (8%), C-arm CT overestimated a direct contact of the esophagus to the left atrium. Conclusions: C-arm computed tomographic image quality without the administration of oral contrast agents was shown to be sufficient for visualization of the esophagus location during a radiofrequency catheter ablation procedure for atrial fibrillation. [Copyright &y& Elsevier]

Copyright of Brazilian Journal of Pulmonology / Jornal Brasileiro de Pneumologia is the property of Sociedade Brasileira de Pneumologia e Tisiologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: Objective: To describe the clinical presentation, diagnostic evaluation, and treatment of bronchoesophageal (BE) fistula due to broncholithiasis, a rare cause of chronic cough with specific therapeutic implications. Methods: Retrospective chart review of 9 patients diagnosed with BE fistulae at our tertiary-care institution between 1964 and 2002. Results: The median age of patients (3 men, 6 women) was 56 years (range, 34–72 years). Six patients had never smoked. Eight presented with intractable cough typically worse after drinking that was relieved by lying on either side; 1 patient presented with dysphagia. Six patients reported lithoptysis, and most had a history of recurrent pneumonia. Chest findings were nonspecific. Diagnosis was established by radiocontrast studies of the esophagus (5 patients), surgical procedures (3), or bronchoscopy (1). Fistulae were right-sided in 7 patients and left-sided in 2. All patients had surgical repair of the fistulae; 6 patients experienced symptom resolution. Conclusion: BE fistula caused by broncholithiasis most commonly affects the right bronchial tree and should be considered in patients with chronic cough associated with drinking, lithoptysis, or recurrent pneumonia. The diagnosis is usually established by radiocontrast studies of the esophagus or incidentally during operations. Surgical repair is required. [Copyright &y& Elsevier]

Background: High-power short-duration (HP-SD) radiofrequency ablation (RFA) has been proposed as a method for producing rapid and effective lesions for pulmonary vein isolation. The underlying hypothesis assumes an increased resistive heating phase and decreased conductive heating phase, potentially reducing the risk for esophageal thermal injury. The objective of this study was to compare the esophageal temperature dynamic profile between HP-SD and moderate-power moderate-duration (MP-MD) RFA ablation strategies. Methods: In patients undergoing pulmonary vein isolation, RFA juxtaposed to the esophagus was delivered in an alternate sequence of HP-SD (50 W, 8-10 s) and MP-MD (25 W, 15-20 s) between adjacent applications (distance, <=4 mm). Esophageal temperature was recorded using a multisensor probe (CIRCA S-CATH). Temperature data included magnitude of temperature rise, maximal temperature, time to maximal temperature, and time return to baseline. In swine, a similar experimental design compared the effect of HP-SD and MP-MD on patterns of esophageal injury. /p> Results: In 20 patients (68.9+/-5.8 years old; 60% persistent atrial fibrillation), 55 paired HP-SD and MP-MD applications were analyzed. The esophageal temperature dynamic profile was similar between HP-SD and MP-MD ablation strategies. Specifically, the magnitude of temperature rise (2.1 [degrees]C [1.4-3] versus 2.0 [degrees]C [1.5-3]; P =0.22), maximal temperature (38.4 [degrees]C [37.8-39.3] versus 38.5 [degrees]C [37.9-39.4]; P =0.17), time to maximal temperature (24.9+/-7.5 versus 26.3+/-6.8 s; P =0.1), and time of temperature to return to baseline (110+/-23.2 versus 111+/-25.1 s; P =0.86) were similar between HP-SD and MP-MD ablation strategies. In 6 swine, esophageal injury was qualitatively similar between HP-SD and MP-MD strategies. Conclusions: Esophageal temperature dynamics are similar between HP-SD and MP-MD RFA strategies and result in comparable esophageal tissue injury. Therefore, when using a HP-SD RFA strategy, the shorter application duration should not prompt shorter intervals between applications. * High-power short-duration radiofrequency ablation has been proposed as a method for producing rapid and effective lesions during pulmonary vein isolation by increasing the resistive heating phase while reducing the conductive heating phase. * However, the effect of high-power short-duration radiofrequency ablation on changes in esophageal temperature and injury has not been well studied. Particularly, it is unknown whether the theoretical assumption of a reduced conductive heating phase translates into an improved safety for ablation close to the esophagus. * The esophageal temperature changes, as well as the magnitude of esophageal injury appears to be similar between high-power short-duration and conventional moderate-power moderate-duration radiofrequency ablation strategies. * If using an high-power short-duration radiofrequency ablation strategy, the shorter application duration should not prompt shorter intervals between applications, as this may increase the risk for esophageal injury. [ABSTRACT FROM AUTHOR]

Esophageal atresia with tracheoesophageal fistula (EA-TEF) is a congenital malformation typically identified during the neonate period. TEFs are classified according to their anatomic configuration. We present a case that demonstrates a unique anomaly that involves a distal TEF with proximal esophageal atresia duplication. Our case reveals the importance of preoperative planning and intraoperative exploration during this surgical procedure. [ABSTRACT FROM AUTHOR]

The experience and number of endoscopic surgery procedures applied in newborns are constantly growing, showing efficacy in many thoracic and abdominal conditions. However, there is an ongoing debate concerning the safety of this technique and the influence on the developing organism. Due to the relatively recent introduction of these methods in the therapy of congenital anomalies, we still have quite little knowledge about their long-term sequelae. The Harlequin phenomenon is a complex, little known and probably heterogeneous anomaly. It involves episodes of sharply demarcated erythema with the dividing line running exactly along the midline. We observe the appearance of episodes of unilateral flushing and sweating on the left half of the body in children who have been operated on using the thoracoscopic approach in the first days of life, due to esophageal atresia and distal tracheooesophageal fistula (EA/TEF), which are very similar to the Harlequin phenomenon. During long term follow-up visits, parents of 2 out of 55 children, who had been operated on during the period 2005–2011, turned our attention to these unusual symptoms. To our knowledge, this is the first report of the Harlequin phenomenon following esophageal surgery. The aim of the study is to analyze the possible pathogenesis of the observed anomaly, in the context of the existing congenital defect, and the operative technique used. [ABSTRACT FROM AUTHOR]

Anastomotic leaks are an unfortunate complication of tracheoesophageal fistula repair. Ongoing anastomotic leaks have been successfully treated with esophageal stent placement. We present the first case report of successful management of an esophago-pleuro-cutaneous fistula using an esophageal stent in a 9-month old patient with VACTERL association while requiring veno-venous extracorporeal membranous oxygenation support. This case report illustrates that complex esophageal injuries can be successfully managed endoscopically in critically ill infants. [ABSTRACT FROM AUTHOR]

Complications from esophageal button battery impactions remain a real fear for practicing pediatric gastroenterologists and surgeons. This case describes a child who developed an aorto-esophageal fistula 25 days after initial battery ingestion and survived due to prompt placement of an aortic stent via minimally invasive surgery, avoiding an open procedure. A 6-year-old female presented acutely with a mid-esophageal button battery impaction witnessed by her parents. Presenting symptoms included chest pain and emesis. Button battery location and size were confirmed on X-ray. She underwent removal with flexible esophagogastroduodenoscopy (EGD) and rigid esophagoscopy. She was admitted to the hospital and received conservative medical management, with serial cross-sectional imaging via chest MRIs to assess the evolution of her injury according to available national guidelines, and was discharged after 12 days of close inpatient monitoring. Despite these measures the patient re-presented 25 days post-ingestion with hematemesis from a new aorto-esophageal fistula, requiring emergent cardiac catheterization with successful, life-saving aortic stent placement. She remained admitted for an additional 12 days of monitoring as her diet was advanced slowly post-catheterization. Since this second hospitalization she continues to do well, with outpatient follow-up by multiple subspecialists. This case highlights the continued uncertainty regarding the risk of developing this complication, as well as gaps in the current literature and guidelines for managing these patients following ingestion and esophageal injury. It also details the unique course following development of this complication and its surgical repair. • Button battery ingestions with esophageal impaction can lead to life-threatening complications. • These complications can occur several weeks after the initial ingestion despite conservative medical management. • Multidisciplinary teamwork resulted in prompt life-saving treatment for this patient. • Minimally invasive aortic stent placement is a possible life-saving intervention in arterio-esophageal fistula development. [ABSTRACT FROM AUTHOR]

Due to the rarity of the association of esophageal and duodenal atresia, no consensus exists regarding the optimal treatment strategy. However, a staged approach is advised in order to reduce morbidities and improve survival. We report a case of a very preterm infant with combined esophageal and duodenal atresia, treated successfully with a staged approach. Treatment consisted in percutaneous radiologic gastrostomy placement prior to tracheoesophageal fistula ligation and esophageal anastomosis, and in delayed duodenal atresia repair. The use of the radiologic approach for gastrostomy placement proved to be minimally invasive, effective and without complications, even in a very preterm baby. [ABSTRACT FROM AUTHOR]

Aspiration via a congenital broncho-esophageal fistula in an adult thoracotomy patient has not been previously reported. Repeated aspiration and subsequent respiratory failure if the fistula is not recognized could be life-threatening in these postoperative patients. We describe one such critical case, in which a broncho-esophageal fistula was discovered weeks after aspiration and the onset of respiratory failure after left lower lobectomy. This unusual case suggests that repeated localized pulmonary infections can indicate a broncho-esophageal fistula and that further investigations should be performed, including detailed history. [ABSTRACT FROM AUTHOR]

Bronchoesophageal fistula is reported in 5-10% of patients with esophageal cancer. In most of these cases, the insertion of a single stent, either a tracheobronchial or an esophageal stent, is sufficient to seal off the fistula. In this case we describe a 67-year-old man with esophageal cancer and complications of bronchoesophageal fistula, which resulted in repeated pneumonia and acute respiratory failure. Initially, two expandable metallic membranous esophageal stents were placed to cover the fistula. However, the esophageal stent failed to stop the air leak and dislodged into the stomach. Thereafter, a bronchial stent was placed at the right intermediate bronchus and successfully stopped the air leak. The patient was then weaned from the ventilator 1 week after the insertion of a bronchial stent. In conclusion, stenting in both the esophagus and airways should be considered when both are severely invaded by malignancy, when the airway is compressed, or when the fistula is insufficiently sealed by an esophageal stent. [Copyright &y& Elsevier]

Abstract: The aorto-esophageal fistula is a well-recognized and potentially fatal complication of thoracic aortic surgery. Several strategies regarding its prevention and subsequent management have been described. We report the management of a large midthoracic fistula complicating redo thoraco-abdominal aortic surgery by the placement of covered stents in the aorta and esophagus to successfully exclude the lesion. While long term durability is uncertain, endografts and long-term antibiotics provide a therapeutic option for palliation in patients unfit for immediate surgery. [Copyright &y& Elsevier]

We report a case of spinal osteomyelitis and fistulous tract between the esophagus and prevertebral soft tissues secondary to an esophageal foreign body. This resulted from a retained gastrostomy bumper that broke on removal of the tube seven years earlier. A 9-year-old male with Troyer Syndrome and developmental delay presented to his pediatrician with the refusal to bear weight and new onset torticollis, and was referred to our institution for further evaluation. He was admitted for further workup due to concern for a neurological process. Imaging revealed osteomyelitis of T3/T4 and inflammatory changes in the posterior mediastinum with possible communication with the esophagus. His gastrostomy tube (GT) was converted to a gastrojejunal tube (GJT) for post-pyloric feeding. He acutely worsened after this procedure, and further radiographic imaging revealed a retained foreign body in the esophagus. An upper endoscopy was subsequently performed with snare removal of the object, identified as the bumper of a previous gastrostomy tube. This esophageal foreign body caused esophageal erosion leading to creation of a fistulous tract with nidus for infection spread posteriorly. The patient underwent prolonged treatment for the infection, with improvement in his presenting symptoms, and eventually resumed gastrostomy feeding. Retained foreign body following gastrostomy removal, while typically does not warrant further investigation, may present with significant sequelae if retained especially in children with developmental delay and feeding difficulties. [ABSTRACT FROM AUTHOR]

The objective of this study was to collect and critically analyze the current evidence on the modalities and results of treatment of descending thoracic aortic surgical graft (SG) and endograft (EG) infection, which represents a rare but dramatic complication after both surgical and endovascular aortic repair. A comprehensive electronic health database search (PubMed/MEDLINE, Scopus, Google Scholar, and the Cochrane Library) identified all articles that were published up to October 2017 reporting on thoracic aortic SG or EG infection. Observational studies, multicenter reports, single-center series and case reports, case-control studies, and guidelines were considered eligible if reporting specific results of treatment of descending thoracic aortic SG or EG infection. Comparisons of patients presenting with SG or EG infection and between invasive and conservative treatment were performed. Odds ratio (OR) meta-analyses were run when comparative data were available. Forty-three studies reporting on 233 patients with infected SG (49) or EG (184) were included. Four were multicenter studies including 107 patients, all with EG infection, associated with a fistula in 91% of cases, with a reported overall survival at 2 years of 16% to 39%. The remaining 39 single-center studies included 49 patients with SG infection and 77 with EG infection. Association with aortoesophageal fistula was significantly more common with EG (60% vs 31%; P =.01). In addition, time interval from index procedure to infection was significantly shorter with EG (17 ± 21 months vs 32 ± 61 months; P =.03). Meta-analysis showed a trend of increased 1-year mortality in patients with SG infection compared with EG infection (pooled OR, 3.6; 95% confidence interval, 0.9-14.7; P =.073). Surgical management with infected graft explantation was associated with a trend toward lower 1-year mortality compared with graft preservation (pooled OR, 0.3; 95% confidence interval, 0.1-1.0; P =.056). Thoracic aortic EG infection is likely to occur more frequently in association with aortoesophageal fistulas and in a shorter time compared with SG infection. Survival is poor in both groups, especially in patients with SG infection. Surgical treatment with graft explantation seems to be the preferable choice in fit patients. [ABSTRACT FROM AUTHOR]

Right thoracotomy for oesophageal atresia (OA) with dextrocardia is technically challenging due to the heart being in the operative field, and also due to the possibility of right-sided aortic arch. We report a neonate with longgap OA with tracheo-oesophageal fistula (TOF), dextrocardia, and left-sided aortic arch who was successfully operated by using right thoracotomy. On the basis of our review of the literature and our experience from this case, we found that conventional right thoracotomy is appropriate for OA+ TOF associated with dextrocardia and left aortic arch, and left thoracotomy in dextrocardia and right aortic arch. [ABSTRACT FROM AUTHOR]

We describe two cases of concomitant Hirschsprung disease and esophageal atresia and tracheoesophageal fistula in the newborn, both of which were successfully diagnosed and managed in the neonatal period. This is the first report in the English literature to identify the coexistence of these distinct congenital malformations. [ABSTRACT FROM AUTHOR]