Abstract
Aim
Oesophagealatresia/tracheo-oesophageal fistula (OA-TOF) is associated with tracheomalacia
(TM). In our institution it is routine for OA-TOF patients to undergo dynamic flexible
bronchoscopy (DFB) assessing both the site of the fistula and the presence or absence
of TM. We aimed to determine the value of this investigation as a screening tool to
predict subsequent symptomatic tracheomalacia in these patients.
Methods
All patients with OA-TOF who underwent DFB at the time of initial repair between June
2014 and November 2016 were included prospectively. The findings at DFB were recorded.
Patients were grouped according to the presence or absence of TM and followed to determine
which of them developed symptomatic airway problems. The sensitivity and specificity
of TM at initial bronchoscopy as a screening tool for subsequent symptomatic TM were
calculated. The study was given ethical approval by our institution.
Main results
Twenty-three patients were included in the study. Median follow-up was for 7 (1–27)
months. Fifteen (65%) were found to have TM at their first DFB; 13 (57%) subsequently
developed airway symptoms, and of these 11 had TM at initial DFB. One patient with
severe TM (>90% tracheal collapse) at initial DFB was completely asymptomatic following OA-TOF
repair. The sensitivity was 85%, and specificity was 60%. The positive and negative
predictive values were 73% and 75%, respectively.
Conclusions
DFB is a useful tool in many aspects of the management of OA/TOF. However, it is not
a good screening tool to predict symptomatic tracheomalacia with moderate sensitivity
and a low specificity.
Level of evidence
Level IIb, Retrospective cohort study.
Key words
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Article info
Publication history
Published online: December 04, 2017
Accepted:
November 8,
2017
Received:
October 29,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
