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Esophageal Atresia & Trachoesophageal Fistula

Esophageal Atresia and Tracheoesophageal Fistula Treatment, Denver

Esophageal Atresia (EA) is the 25th most common birth defect, presenting in about 1 in 4,000 live births. It occurs when the esophagus (the tube connecting the mouth to the stomach) forms abnormally. It often is associated with tracheoesophageal fistula (TEF) in which the esophagus is connected to the trachea (windpipe). The experts at Rocky Mountain Hospital for Children are skilled in diagnosing and treating this condition. Our staff is specially trained to care for the needs of an EA and TEF newborn, and the pediatric surgeons of Rocky Mountain Pediatric Surgery are highly experienced in correcting this issue surgically.

About Esophageal Atresia/Tracheoesophageal Fistula

In babies with esophageal atresia, the esophagus failed to develop into one straight tube from the mouth to the stomach. Instead, it formed into two separate segments that do not connect. There are five types of EA:

  • Esophageal Atresia: The upper and lower segments of the esophagus do not connect and end in pouches. The trachea is unaffected.
  • Atresia with Proximal Fistula: The lower segment ends in a pouch, but the upper segment is attached to the trachea (TEF).
  • Atresia with Distal Fistula: The upper segment ends in a pouch, but the lower segment is attached to the trachea (TEF). This type is most common.
  • Atresia with Double Fistula: The upper and lower segments are connected to the trachea.
  • Tracheoesophageal Fistula: The esophagus is one complete tube, but the lower part is connected to the trachea.

There is no known cause for EA and TEF, but an estimated 50 percent of babies with EA and TEF have another birth defect. Most commonly, they have other conditions linked to a group of congenital defects called VACTERL: vertebral, imperforate anus, cardiac, TF/EA, rectal or kidney and limbs.

Esophageal Atresia/Tracheoesophageal Fistula Diagnosis

Most often, EA and TEF are diagnosed after birth. The baby may be unable to swallow, cannot feed normally (coughing, choking or blue skin while feeding), has breathing problems, creates frothy white bubbles at the mouth, vomits and/or has a round full abdomen. If EA and TEF are suspected, your physician may try to pass a tube (called a nasogastric tube or NG tube) from the mouth to stomach and then visualize the area with an X-ray.

Sometimes, EA and TEF are strongly suspected before birth during an ultrasound. If the stomach is small or not visible, EA and TEF are suspected. Because babies swallow amniotic fluid during pregnancy, and EA and TEF babies are unable to swallow properly, a buildup of amniotic fluid may occur, called polyhydramnios, which can cause preterm labor. Babies with suspected EA and TEF during pregnancy will be monitored closely throughout the pregnancy by specialized perinatologists (such as those at the Center for Maternal Fetal Health) and a careful plan of delivery at a hospital equipped with a Level IV NICU, neonatologists and experienced pediatric surgeons is made.

Esophageal Atresia/Tracheoesophageal Fistula Treatment

Surgery is always the treatment for esophageal atresia/tracheoesophageal fistula. If left untreated, it can be life-threatening and lead to long-term nutritional concerns. However, with proper treatment from highly knowledgeable surgeons and staff in a facility equipped to handle the unique needs of a newborn, most children recover fully from this condition. Depending on the severity and type of EA and TEF, your medical team will prepare for surgery as soon as possible, usually within the first 24 hours after birth. The surgeons at Rocky Mountain Pediatric Surgery are highly experienced in thoracoscopic (minimally invasive) procedures, and performed the first thoracoscopic repair of a TEF in the world in 2000. This type of surgery uses smaller incisions, leading to less post-operative pain and shorter recovery times.  Using tiny cameras and instruments, the surgeon will connect the pieces of the esophagus and/or separate the trachea to create two separate, complete, functioning tubes.

Long-Term Outlook for Esophageal Atresia/Trachoesophageal Fistula

Most babies recover well from this condition and do not have serious lingering effects. The most common long-term effect of EA/TEF is GERD: gastroesophageal reflux disease. This condition can be well managed with medication and follow up care. Another complication is scar tissue built up around the esophagus making swallowing difficult or painful. This often can be repaired during a later surgery.

To find pediatric surgeon in Denver experienced in Esophageal Atresia/Trachoesophageal Fistula treatment, contact our program care coordinator at 720-754-4902.