Complications
Faltering growth is common among children who have undergone esophageal atresia repair.[48]
In one long-term follow-up study, around 80% of adults who had esophageal atresia/tracheoesophageal fistula (EA/TEF) surgically corrected as infants complained of some difficulty swallowing. While many stated that this did not affect their overall quality of life or food choices, 13% required endoscopic foreign body removal.[37]
One systematic review summarizing 65 peer-reviewed publications found high rates of esophageal dysmotility, GERD, esophagitis, and dysphagia in patients with a history of surgically corrected EA.[38] GERD occurs due to poor esophageal motility and a congenitally short esophagus. After a 10-year follow-up, 100% of patients in one study were found to have esophageal dysmotility by manometry.[39] The initial method of therapy is medical treatment, but 50% of patients will require an antireflux procedure.[13][40][41][42][43]
Long-term surveillance of GERD after EA/TEF repair is required given the incidence of ongoing esophagitis.[44] In one study, the incidence of intestinal metaplasia was 10 times higher than in the general pediatric population.[45]
Typically, patients present with choking, gagging, and feed intolerance.[46] This can occur due to GERD or secondary to tension and resultant stricture of anastomosis site. Initial treatment includes H2 blockers, and approximately 10% to 20% of patients will require 1 or more esophageal dilations.[43][47]
Often the cartilaginous wall of an infant with tracheosophageal fistula is weak. This wall may collapse during inspiration causing near complete airway obstruction. This may result in symptoms which range from noisy breathing and severe dyspnea on exertion to near death or cyanotic spells. If these symptoms occur, the patient should be referred for bronchoscopy. If the patient has significant GERD, bronchoscopy may worsen symptoms. Symptoms usually resolve as the trachea matures and the cartilages become stiffer; however, severe cases may require procedures such as an aortopexy, tracheopexy or even tracheostomy.
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