Endoscopic tracheoesophageal fistula closure—Electrocautery combined with esophageal clip application in pediatric patients

OBJECTIVE: A tracheoesophageal fistula (TEF) is an abnormal communication between the esophagus and trachea, most often associated with esophageal atresia (EA), a rare congenital malformation affecting 1 in 2400-4500 live births. While surgical repair of EA/TEF is typically completed in infancy, recurrent or missed TEF can be diagnosed later. Open repair can be technically challenging, often requiring re-do thoracotomy or neck dissection. We describe our center's experience, using endoscopic electrocautery in combination with esophageal clips for closure of TEF. METHODS: We conducted a retrospective review of all patients who underwent an endoscopic TEF repair with esophageal clip application at our institution (IRB# 20-021016). All patients underwent triple endoscopy (flexible bronchoscopy, esophagogastroduodenoscopy, and rigid bronchoscopy) with pulmonary, gastroenterology (GI), and otolaryngology (ENT). Electrocautery was performed on the tracheal side by ENT or pulmonary and esophageal clip placement by GI. RESULTS: Between November 2019 and February 2025, 14 patients underwent successful endoscopic closure of 15 TEF. One patient failed endoscopic closure of a proximal missed congenital TEF but had successful endoscopic closure of their recurrent TEF. Ten TEF were closed with electrocautery and esophageal clip placement while five were closed with cautery alone. No significant complications occurred, and all closures were confirmed with follow-up endoscopy. CONCLUSION: Endoscopic electrocautery with esophageal clip application, by a skilled multidisciplinary team, offers a minimally invasive alternative to open repair for missed congenital, recurrent, and acquired TEFs. It may be considered as a first line approach, especially in patients with high surgical risk.