Gomez Zuleta MA, Gallego Ospina DM, Ruiz OF. Tracheoesophageal fistulas in coronavirus disease 2019 pandemic: A case report. World J Gastrointest Endosc 2022; 14(10): 628-635 [PMID: 36303807 DOI: 10.4253/wjge.v14.i10.628]
Corresponding Author of This Article
Martin Gomez, MD, Adjunct Associate Professor, Department of internal medicine, Gastroenterology unit, Universidad Nacional de Colombia, Carrera 45 No. 26-85 Bogota 11321, Colombia. email@example.com
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Tracheoesophageal fistulas in coronavirus disease 2019 pandemic: A case report
Martin Alonso Gomez Zuleta, Daniel Mauricio Gallego Ospina, Oscar Fernando Ruiz
Martin Alonso Gomez Zuleta, Daniel Mauricio Gallego Ospina, Oscar Fernando Ruiz, Department of Internal Medicine, Gastroenterology unit, Universidad Nacional de Colombia, Bogota 11321, Colombia
Author contributions: Gomez M was responsible for the revision of the manuscript for important intellectual content; Gallego D and Ruiz O reviewed the literature and contributed to manuscript drafting; all authors were the patient’s gastroenterologists; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed consent was obtained from each of the patients or their legal representatives.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Martin Gomez, MD, Adjunct Associate Professor, Department of internal medicine, Gastroenterology unit, Universidad Nacional de Colombia, Carrera 45 No. 26-85 Bogota 11321, Colombia. firstname.lastname@example.org
Received: March 10, 2022 Peer-review started: March 10, 2022 First decision: June 16, 2022 Revised: July 13, 2022 Accepted: September 13, 2022 Article in press: September 13, 2022 Published online: October 16, 2022
Tracheoesophageal fistulas (TEFs) can be described as a pathological communication between the trachea and the esophagus. According to their origin, they may be classified as benign or malignant. Benign TEFs occur mostly as a consequence of prolonged mechanical ventilation, particularly among patients exposed to endotracheal cuff overinflation. During the severe acute respiratory syndrome coronavirus 2 virus pandemic, the amount of patients requiring prolonged ventilation rose, which in turn increased the incidence of TEFs.
We report the cases of 14 patients with different comorbidities such as being overweight, or having been diagnosed with diabetes mellitus or systemic hypertension. The most common symptoms on arrival were dyspnea and cough. In all cases, the diagnosis of TEFs was made through upper endoscopy. Depending on the location and size of each fistula, either endoscopic or surgical treatment was provided. Eight patients were treated endoscopically. Successful closure of the defect was achieved through over the scope clips in two patients, while three of them required endoscopic metal stenting. A hemoclip was used to successfully treat one patient, and it was used temporarily for another patient pended surgery. Surgical treatment was performed in patients with failed endoscopic management, leading to successful defect correction. Two patients died before receiving corrective treatment and four died later on in their clinical course due to infectious complications.
The incidence of TEFs increased during the coronavirus disease 2019 pandemic (from 0.5% to 1.5%). We believe that endoscopic treatment should be considered as an option for this group of patients, since evidence reported in the literature is still a growing area. Therefore, we propose an algorithm to lead intervention in patients presenting with TEFs due to prolonged intubation.
Core Tip: Due to the significant increase of tracheoesophageal fistulas in the context of severe coronavirus disease 2019 (COVID-19) pneumonia, and the high frequency of risk factors in patients with COVID-19, we recommend early identification and correction of these factors, such as frequent measurement of the cuff pressure and, if possible, periodic evaluation of the tracheal mucosa with bronchoscopy to identify early precursor lesions of tracheoesophageal fistula. Regarding treatment, provide initial endoscopic management until optimal conditions for surgical management are reached. Endoscopic management should be selected according to the size and location of the fistula.