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.