SOME FACTORS RELATED TO THE OUTCOME OF ESOPHAGEAL CLOSURE WITH 50% TRICHLOACETIC ACID VIA BRONCHOSCOPY IN CHILDREN AT THE NATIONAL PEDIATRIC HOSPITAL
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Abstract
Background: Tracheoesophageal fistula (TEF) is an abnormal communication between the esophagus and the trachea, allowing gastrointestinal contents to enter the airway and leading to recurrent and chronic respiratory complications. The incidence of congenital TEF is estimated at approximately 1 in 2,000–4,000 live births. Various bronchoscopic techniques have been used for fistula closure, including biological glue application, sclerotherapy, laser, and electrocautery, all of which share a common mechanism of inducing mucosal injury followed by fibrosis and fistula closure. Among these, trichloroacetic acid (TCA) has shown promising results due to its high efficacy, minimal invasiveness, and low cost. This method has been implemented at the National Children’s Hospital since 2017 with a high success rate. However, some patients still experience treatment failure or require multiple interventions.
Objective: To identify factors associated with the outcomes of bronchoscopic closure of tracheoesophageal fistula using 50% trichloroacetic acid in children at the National Children’s Hospital.
Methods: A descriptive study was conducted on 36 pediatric patients with TEF treated by bronchoscopic application of 50% TCA from 2017 to May 2025.
Results: Factors such as associated anomalies, esophageal stricture, tracheomalacia, fistula location, and large fistula size (>3 mm) were not significantly associated with failure rates or the number of closure procedures. Higher body weight at the time of fistula closure showed a trend toward lower failure rates, although this did not reach statistical significance. However, greater body weight was significantly associated with a reduced likelihood of requiring two or more closure attempts.
Conclusions: The effectiveness of bronchoscopic closure of TEF using 50% TCA does not appear to be significantly influenced by associated conditions or anatomical characteristics. Body weight at the time of intervention may be an important factor associated with the number of procedures required.
Keywords
tracheoesophageal fistula, trichloroacetic acid, bronchoscopy, associated factors
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References
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