Esophageal atresia and tracheoesophageal fistula care in Denver
Esophageal atresia (EA) presents in about one in 4,000 live births. It occurs when the esophagus (tube connecting the mouth to the stomach) forms abnormally. In babies with EA, 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.
EA is often associated with tracheoesophageal fistula (TEF), in which the esophagus is connected to the trachea (windpipe). Our team at Rocky Mountain Hospital for Children (RMHC) are world leaders in the minimally invasive treatment of newborns with EA or TEF.
In addition, the pediatric surgeons of Rocky Mountain Pediatric Surgery are highly experienced in correcting this issue surgically.
Types of EA
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 upper 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 abnormality. Most commonly, they have other conditions linked to a group of abnormalities called VACTERL: vertebral, imperforate anus, cardiac, TF/EA, rectal or kidney and limbs.
EA and TEF 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 the 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 our Center for Maternal/Fetal Health) and a careful plan of delivery at a hospital equipped with a Level IV Neonatal Intensive Care Unit (NICU), neonatologists and experienced pediatric surgeons is developed.
EA and TEF treatment
Minimally invasive surgery is used as the treatment for esophageal atresia and 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 recovery 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 procedures. Our team performed the first thoracoscopic repair—a minimally invasive, image-guided technique offering superior visualization for treating conditions of the chest—of 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 EA/TEF
Most babies recover well from this condition and do not have serious lingering effects. The most common, long-term effect of EA/TEF is gastroesophageal reflux disease (GERD). 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 a pediatric surgeon in Denver experienced in EA/TEF treatment, contact our Center for Maternal/Fetal Health at (720) 754-7642