Endoscopic management of recurrent tracheoesophageal fistula with trichloroacetic acid in pediatric patients. / Manejo endoscópico de la fístula traqueoesofágica recurrente con la aplicación de ácido tricloroacético, en el paciente pediátrico.

INTRODUCTION: Surgical repair of recurrent tracheoesophageal fistula has a high risk of complications. Therefore, various endoscopic techniques have been used to avoid complications. OBJECTIVE: To understand the usefulness of trichloroacetic acid endoscopic application for the treatment of recurrent tracheoesophageal fistula. MATERIALS AND METHODS: An observational, descriptive, retrospective, case-series-based study was carried out in a tertiary pediatric hospital. Records of patients with recurrent tracheoesophageal fistula from 2015 to 2021 were reviewed. All patients within this period underwent brushing and trichloroacetic acid application. RESULTS: Mean time of recurrent tracheoesophageal fistula occurrence was 4.8 months (range: 1-19.2). Two patients had a small fistula (less than 4 mm), three patients had a medium fistula (4 mm), and two patients had a large fistula (more than 4 mm). Mean sessions for fistula closure were 2.2 (range: 1-4). Mean time between procedures was 22 days (range: 14-30). Mean follow-up since fistula closure confirmation was 33 months (range: 9-72), during which no recurrences were noted. CONCLUSION: Endoscopic management of recurrent transesophageal fistula with trichloroacetic acid is a safe and effective procedure. Brushing and trichloroacetic acid combined improve success rates. Fistulas over 4 mm in diameter require more procedures. However, a larger patient cohort and a longer follow-up period are needed to confirm this.

INTRODUCCION: La reparación quirúrgica de la fístula traqueoesofágica recurrente tiene alto riesgo de complicaciones por lo que se han utilizado diversas técnicas endoscópicas para evitarlas. OBJETIVO: Conocer la utilidad de la aplicación endoscópica de ácido tricloroacético para el tratamiento de la fístula traqueoesofágica recurrente. MATERIAL Y METODO: Estudio observacional, descriptivo y retrospectivo, tipo de serie de casos en un hospital pediátrico de tercer nivel. Se revisaron los expedientes de pacientes con fístula traqueoesofágica recurrente de 2015 a 2021. En todos los pacientes durante este periodo se realizó cepillado y aplicación de ácido tricloroacético. RESULTADO: El tiempo medio de aparición de la fístula traqueoesofágica recurrente fue de 4,8 meses (rango 1-19,2). Dos con fístula pequeña (menor a 4 mm), tres con fístula mediana (4 mm) y dos con fístula grande (mayor a 4 mm). El número medio de sesiones para cerrar la fístula fue 2,2 veces (rango 1-4). El intervalo medio entre procedimientos fue 22 días (rango 14-30). El tiempo medio de seguimiento desde la confirmación de cierre de la fistula fue de 33 meses (rango 9-72), periodo de tiempo donde no se observó recurrencia del cuadro. CONCLUSION: El manejo endoscópico de la fístula traqueoesofágica recurrente con la aplicación de ácido tricloroacético es un procedimiento seguro y efectivo. La técnica de cepillado y aplicación de ácido tricloroacético mejora la efectividad de éxito. La fístula mayor de 4 mm de diámetro requiere mayor número de procedimientos; sin embargo, se requiere mayor número de pacientes y mayor tiempo de seguimiento para poder aseverar esta opinión.

Manejo endoscópico de la fístula traqueoesofágica recurrente con la aplicación de ácido tricloroacético, en el paciente pediátrico / Endoscopic management of recurrent tracheoesophageal fistula with trichloroacetic acid in pediatric patients

Introducción: La reparación quirúrgica de la fístula traqueoeso-fágica recurrente tiene alto riesgo de complicaciones por lo que se hanutilizado diversas técnicas endoscópicas para evitarlas. Objetivo: Conocer la utilidad de la aplicación endoscópica deácido tricloroacético para el tratamiento de la fístula traqueoesofágicarecurrente. Material y método: Estudio observacional, descriptivo y retros-pectivo, tipo de serie de casos en un hospital pediátrico de tercer nivel.Se revisaron los expedientes de pacientes con fístula traqueoesofágicarecurrente de 2015 a 2021. En todos los pacientes durante este periodose realizó cepillado y aplicación de ácido tricloroacético. Resultado: El tiempo medio de aparición de la fístula traqueoesofá-gica recurrente fue de 4,8 meses (rango 1-19,2). Dos con fístula pequeña(menor a 4 mm), tres con fístula mediana (4 mm) y dos con fístula grande(mayor a 4 mm). El número medio de sesiones para cerrar la fístula fue2,2 veces (rango 1-4). El intervalo medio entre procedimientos fue 22días (rango 14-30). El tiempo medio de seguimiento desde la confir-mación de cierre de la fistula fue de 33 meses (rango 9-72), periodo detiempo donde no se observó recurrencia del cuadro. Conclusión: El manejo endoscópico de la fístula traqueoesofágica recurrente con la aplicación de ácido tricloroacético es un procedimientoseguro y efectivo. La técnica de cepillado y aplicación de ácido triclo-roacético mejora la efectividad de éxito. La fístula mayor de 4 mm dediámetro requiere mayor número de procedimientos; sin embargo, serequiere mayor número de pacientes y mayor tiempo de seguimientopara poder aseverar esta opinión.(AU)

Introduction: Surgical repair of recurrent tracheoesophageal fistulahas a high risk of complications. Therefore, various endoscopic tech-niques have been used to avoid complications. Objective: To understand the usefulness of trichloroacetic acid en-doscopic application for the treatment of recurrent tracheoesophageal fistula. Materials and methods: An observational, descriptive, retrospec-tive, case-series-based study was carried out in a tertiary pediatric hos-pital. Records of patients with recurrent tracheoesophageal fistula from2015 to 2021 were reviewed. All patients within this period underwentbrushing and trichloroacetic acid application. Results: Mean time of recurrent tracheoesophageal fistula occur-rence was 4.8 months (range: 1-19.2). Two patients had a small fistula(less than 4 mm), three patients had a medium fistula (4 mm), and twopatients had a large fistula (more than 4 mm). Mean sessions for fistulaclosure were 2.2 (range: 1-4). Mean time between procedures was 22days (range: 14-30). Mean follow-up since fistula closure confirmationwas 33 months (range: 9-72), during which no recurrences were noted. Conclusion: Endoscopic management of recurrent transesophagealfistula with trichloroacetic acid is a safe and effective procedure. Brush-ing and trichloroacetic acid combined improve success rates. Fistulasover 4 mm in diameter require more procedures. However, a largerpatient cohort and a longer follow-up period are needed to confirm this.(AU)

Efficacy of 1-day vs. 2-day intestinal preparation using peg 3350 + Bisacodyl: A randomized clinical trial. / Eficacia de la preparación intestinal con un día de PEG 3350 + bisacodilo en comparación con dos días: ensayo clínico aleatorizado.

OBJECTIVE: The objective was to compare the efficacy of 1-day intestinal preparation for colonoscopy using PEG 3350 (polyethylene glycol) (4 g/kg/day) + bisacodyl vs. 2-day intestinal preparation using PEG 3350 (2 g/kg/day) + bisacodyl in pediatric patients. MATERIALS AND METHODS: A blind, randomized clinical trial was carried out with endoscopists who assessed colon cleansing. Patients aged 2-18 years old undergoing scheduled colonoscopy were included. They were randomized into 2 groups: 1-day preparation using PEG 3350 (4 g/kg/day) + bisacodyl, and 2-day preparation using PEG 3350 (2 g/kg/day) + bisacodyl. Endoscopic evaluation (Boston Scale) allowed the efficacy of both preparations to be assessed. Statistical analysis: T of Student for quantitative variables, and Chi square for qualitative variables. RESULTS: 72 patients with a mean age of 94 ± 49 months were included. No significant difference was found between groups regarding preparation difficulty and safety. Efficacy, assessed using the Boston Scale score and the proportion of excellent and good grades achieved, was higher in the 1-day group. Left colon score and total score were higher than in the 2-day group (left colon: 2.20 vs. 1.89, p=0.03; total score: 7.28 vs. 6.76, p=0.01) (left colon: 94.4% vs. 83.4%, p=0.034). CONCLUSIONS: Efficacy in the quality of intestinal preparation for colonoscopy was higher in the 1-day group using PEG 3350 + oral bisacodyl than in the 2-day group.

OBEJTIVO: Comparar la eficacia de la preparación intestinal para colonoscopia con 1 día de preparación con PEG 3350 (polietilenglicol) (4 g/kg/día) + bisacodilo en comparación con 2 días de preparación con PEG 3350 (2 g/kg/día) + bisacodilo en pacientes pediátricos. MATERIAL Y METODOS: Se realizó un ensayo clínico, aleatorizado y cegado para los médicos endoscopistas que evaluaron la limpieza del colon. Se incluyeron pacientes de 2 a 18 años, que ameritaban colonoscopia en forma programada. Se aleatorizaron a los pacientes en dos grupos: 1 día de preparación con PEG 3350 (4 g/kg/día) + bisacodilo y 2 días de preparación con PEG 3350 (2 g/kg/día) + bisacodilo. Por medio de valoración endoscópica (escala de Boston) se determinó la eficacia de las dos preparaciones a evaluar. Análisis estadístico: T de student para cuantitativas y Chi2 para cualitativas. RESULTADOS: Se incluyeron 72 pacientes con edad promedio de 94 ± 49 meses. No hubo diferencia significativa entre los grupos con respecto a la dificultad y seguridad de la preparación. La eficacia, evaluada por el puntaje de la escala de Boston y la proporción de calificación excelente o buena, fue mejor en el grupo de un 1 día, el colon izquierdo y el puntaje total fue mejor en comparación al grupo de 2 días (colon izquierdo 2,20 vs. 1,89 p= 0,03 y total 7,28 vs. 6,76 p= 0,01) (colon izquierdo 94,4 vs. 83,4% p= 0,034). CONCLUSIONES: La eficacia de la calidad en la preparación intestinal para colonoscopia fue mejor entre el grupo de 1 día con PEG 3350 + bisacodilo vía oral en comparación a la preparación de 2 días.

Eficacia de la preparación intestinal con un día de PEG 3350 + bisacodilo en comparación con dos días: ensayo clínico aleatorizado / Efficacy of 1-day vs. 2-day intestinal preparation using peg 3350 + bisacodyl: A randomized clinical trial

Objetivo: Comparar la eficacia de la preparación intestinal para colonoscopia con 1 día de preparación con PEG 3350 (polietilenglicol) (4 g/kg/día) + bisacodilo en comparación con 2 días de preparación con PEG 3350 (2 g/kg/día) + bisacodilo en pacientes pediátricos. Material y métodos: Se realizó un ensayo clínico, aleatorizado y cegado para los médicos endoscopistas que evaluaron la limpieza del colon. Se incluyeron pacientes de 2 a 18 años, que ameritaban colonoscopia en forma programada. Se aleatorizaron a los pacientes en dos grupos: 1 día de preparación con PEG 3350 (4 g/kg/día) + bisacodilo y 2 días de preparación con PEG 3350 (2 g/kg/día) + bisacodilo. Por medio de valoración endoscópica (escala de Boston) se determinó la eficacia de las dos preparaciones a evaluar. Análisis estadístico: T de student para cuantitativas y Chi2 para cualitativas. Resultados: Se incluyeron 72 pacientes con edad promedio de 94 ± 49 meses. No hubo diferencia significativa entre los grupos con respecto a la dificultad y seguridad de la preparación. La eficacia, evaluada por el puntaje de la escala de Boston y la proporción de calificación excelente o buena, fue mejor en el grupo de un 1 día, el colon izquierdo y el puntaje total fue mejor en comparación al grupo de 2 días (colon izquierdo 2,20 vs. 1,89 p = 0,03 y total 7,28 vs. 6,76 p = 0,01) (colon izquierdo 94,4 vs. 83,4% p = 0,034). Conclusiones: La eficacia de la calidad en la preparación intestinal para colonoscopia fue mejor entre el grupo de 1 día con PEG 3350 + bisacodilo vía oral en comparación a la preparación de 2 días

Objective: The objective was to compare the efficacy of 1-day intestinal preparation for colonoscopy using PEG 3350 (polyethylene glycol) (4 g/kg/day) + bisacodyl vs. 2-day intestinal preparation using PEG 3350 (2 g/kg/day) + bisacodyl in pediatric patients. Materials and methods: A blind, randomized clinical trial was car-ried out with endoscopists who assessed colon cleansing. Patients aged 2-18 years old undergoing scheduled colonoscopy were included. They were randomized into 2 groups: 1-day preparation using PEG 3350 (4 g/kg/day) + bisacodyl, and 2-day preparation using PEG 3350 (2 g/kg/day) + bisacodyl. Endoscopic evaluation (Boston Scale) allowed the efficacy of both preparations to be assessed. Statistical analysis: T of Student for quantitative variables, and Chi square for qualitative variables. Results: 72 patients with a mean age of 94 ± 49 months were included. No significant difference was found between groups regarding preparation difficulty and safety. Efficacy, assessed using the Boston Scale score and the proportion of excellent and good grades achieved, was higher in the 1-day group. Left colon score and total score were higher than in the 2-day group (left colon: 2.20 vs. 1.89, p = 0.03; total score: 7.28 vs. 6.76, p = 0.01) (left colon: 94.4% vs. 83.4%, p = 0.034). Conclusions: Efficacy in the quality of intestinal preparation for colonoscopy was higher in the 1-day group using PEG 3350 + oral bisacodyl than in the 2-day group

Epiglottopexy by external puncture for epiglottic prolapse in severe laryngomalacia. A novel technique.

INTRODUCTION: Laryngomalacia (LM) is the first cause of stridor in infants. 10 to 20% of patients with LM may require surgery due to the development of severe symptoms. Supraglottoplasty is the most commonly performed surgery for severe LM. However, it is insufficient for the rostrocaudal displacement of the epiglottis against the posterior pharyngeal wall. CASE SUMMARY: We report a case of a 2-month-old infant with severe laryngomalacia with a remarkable collapse of the epiglottis towards the glottis with secondary obstruction of the airway, alteration in swallowing and failure to thrive. The patient was treated satisfactorily through epiglottopexy by an external puncture. During a follow-up of 2 years, the patient has been asymptomatic, without any adverse event. DISCUSSION: Glottic obstruction from posterior epiglottic collapse is the most severe type of laryngomalacia, generating severe respiratory symptoms and failure to thrive. Epiglottopexy by external puncture is a new technique, certainly affordable since it does not require special instruments and it can be performed in medical centers through suspension laryngoscopy. It can be achieved alone or in combination with traditional supraglottoplasty.

[Foreign bodies aspiration in pediatrics. 15-year experience. Analysis of 337 cases]. / Aspiración de cuerpos extraños en pediatría. Experiencia de 15 años. Análisis de 337 casos.

Foreign body aspiration is a pediatric urgency that occurs primarily between 1 and 3 years old. The aim of this paper is to present the symptomatology, clinical and radiological findings, and the therapeutic used in our hospital with patients with foreign body aspiration diagnosis from 1995 until 2011. Patient's age was between 0 and 16 years old. We included 337 patients; where males predominate (205). The medium age was 23 months. The most frequent foreign bodies founded were seeds (192) in 57% and metallic objects in 18.3%. Cough (74.5%), dyspnea (70%), cyanosis (42.4%) and stridor (26%), were the main symptoms. Right bronchus was the most frequent localization (37.7%). In 21% of the patients the reference diagnostic was wrong due to treating it as a respiratory infection. All foreign bodies were extracted by rigid bronchoscopy. No deaths were reported in any proceeding. In our experience, infants are the most affected group, and the primordial symptoms are cough and dyspnea. Organic objects had the highest prevalence of aspiration.

Aspiración de cuerpos extraños en pediatría. Experiencia de 15 años. Análisis de 337 casos / Foreign bodies aspiration in pediatrics. 15-year experience. Analysis of 337 cases

La aspiración de un cuerpo extraño es una urgencia pediátrica y ocurre principalmente entre 1 y 3 años de edad. El objetivo de este trabajo es presentar la sintomatología, hallazgos clínicos, radiológicos y la terapéutica empleada en nuestro hospital de pacientes con diagnóstico de aspiración de cuerpo extraño desde 1995 a 2011. El grupo de edad fue desde el nacimiento hasta los 16 años. Se encontraron 337 pacientes, en los cuales predominó el sexo masculino (205). La mediana de edad fue de 23 meses. Los cuerpos extraños más frecuentes fueron las semillas con 192 (57%) y los objetos metálicos 18,3%. Del total de casos, 74,5% presentaron tos, 70% sensación de ahogamiento, 42,4% cianosis y 26% estridor. El sitio de localización más frecuente fue el bronquio derecho (37,7%). En el 21% el diagnóstico de referencia fue erróneo, ya que se manejó como una infección respiratoria. Todos los cuerpos se extrajeron por broncoscopia rígida. No hubo defunciones. En nuestra experiencia, los lactantes mayores son el grupo etario más afectado, presentándose con tos y dificultad respiratoria súbita, siendo los objetos orgánicos los más aspirados (AU)

Foreign body aspiration is a pediatric urgency that occurs primarily between 1 and 3 years old. The aim of this paper is to present the symptomatology, clinical and radiological findings, and the therapeutic used in our hospital with patients with foreign body aspiration diagnosis from 1995 until 2011. Patient’s age was between 0 and 16 years old. We included 337 patients; where males predominate (205). The medium age was 23 months. The most frequent foreign bodies founded were seeds (192) in 57% and metallic objects in 18.3%. Cough (74.5%), dyspnea (70%), cyanosis (42.4%) and stridor (26%), were the main symptoms. Right bronchus was the most frequent localization (37.7%). In 21% of the patients the reference diagnostic was wrong due to treating it as a respiratory infection. All foreign bodies were extracted by rigid bronchoscopy. No deaths were reported in any proceeding. In our experience, infants are the most affected group, and the primordial symptoms are cough and dyspnea. Organic objects had the highest prevalence of aspiration (AU)

[Anterior approach for the surgical treatment of a laryngotracheoesophageal cleft]. / Abordaje anterior para el tratamiento quirúrgico de la hendidura laringotraqueoesofágica.

Laryngotracheoesophageal clefts (LTEC) are rare and potentially lethal malformations. Their therapeutic approach is still controversial. We report on a one month old infant with a type III LTEC who presented with aspiration and was fed through an orogastric tube for three weeks. Rigid endoscopy assessed the defect precisely. A percutaneous transendoscopic gastrostomy was done one week before the one stage anterior translaryngeal approach of the defect with a two-layer repair. The patient was orotracheally intubated, sedated and relaxed for four days after the repair. Three years later, his larynx and esophagus function normally. Rigid endoscopy and an anterior translaryngeal surgical approach were helpful in his management.

Abordaje anterior para el tratamiento quirúrgico de la hendidura laringotraqueoesofágica / Anterior approach for the surgical treatment of a laryngotracheoesophageal cleft

La hendidura laringotraqueoesofágica (HLTE) es una malformación rara y potencialmente letal. Su tratamiento es controvertido. Presentamos un lactante con HLTE tipo III y episodios de aspiración desde el nacimiento. Fue alimentado con sonda orogástrica por tres semanas. La endoscopia rígida determinó la extensión del defecto. Se efectuó gastrostomía endoscópica una semana previa al abordaje anterior translaríngeo en un tiempo quirúrgico, con reparación en dos planos. La intubación orotraqueal con sedación y relajación se mantuvo durante cuatro días. Tres años después, laringe y esófago funcionan normalmente. La endoscopia rígida y el abordaje quirúrgico anterior translaríngeo fueron muy útiles (AU)

Laryngotracheoesophageal clefts (LTEC) are rare and potentially lethal malformations. Their therapeutic approach is still controversial. We report on a one month old infant with a type III LTEC who presented with aspiration and was fed through an orogastric tube for three weeks. Rigid endoscopy assessed the defect precisely. A percutaneous transendoscopic gastrostomy was done one week before the one stage anterior translaryngeal approach of the defect with a two-layer repair. The patient was orotracheally intubated, sedated and relaxed for four days after the repair. Three years later, his larynx and esophagus function normally. Rigid endoscopy and an anterior translaryngeal surgical approach were helpful in his management (AU)

Preoperative catheterization of H-type tracheoesophageal fistula to facilitate its localization and surgical correction.

PURPOSE: The aim of this study was to demonstrate that preoperative catheterization of H-type tracheoesophageal fistula facilitates its identification and surgical correction. METHODS: This is a case series of seven patients with H-type tracheoesophageal fistula. Diagnosis was established in three patients and suspected in two more by means of an esophagogram. Confirmation of fistula was performed by endoscopy in all patients. On the day of surgery, either a rigid bronchoscope or a nasolaryngoscope was introduced into the trachea to localize and catheterize the fistula. Because of the location of the fistula, the surgical correction was performed through the neck in five patients and through the thorax in two patients. The fistulas were easily identified surgically and the corrections were successfully performed in all cases. An extensive dissection was not required in any case. Refistulization, identified by bronchoscopic examination one week after surgery, occurred in one patient. Surgical repair was performed again using same procedure described above. All patients are currently asymptomatic and without any evidence of refistulization. CONCLUSIONS: Preoperative catheterization of H-type tracheoesophageal fistula is useful to facilitate its preoperative identification, to plan the surgical approach, and to decrease operating times and the extent of surgery.

A new endoscopic procedure for membranectomy of fenestrated duodenal membranes.

AIM OF THE STUDY: We describe a new endoscopic procedure for membranectomy of fenestrated duodenal membranes. METHODS: With the patients under general anesthesia and tracheally intubated, a flexible video-panendoscope was introduced into the second portion of the duodenum. The fenestrated membrane was visualized and a triple-lumen stone extraction balloon of 15 mm was inserted through the fenestration. After the balloon was insufflated, gentle traction was performed in order to expose the fenestrated membrane and differentiate it from the normal duodenal wall. The orifice was dilated in order to introduce the endoscope and localize the Vater's ampulla. A sphincterotome was used to carry out one or two incisions of 1.5 to 2 cm in the membrane in the opposite direction to the ampulla. RESULTS: The procedure was successfully performed in five patients with a mean surgical time of 50 minutes. None of the patients complained of postoperative pain. Peristalsis was not affected, and patients started intake of oral fluids at approximately 24 hours. On discharge patients were completely asymptomatic, and four patients were followed up for one year following the procedure and remained asymptomatic. One patient who was also asymptomatic did not continue follow-up longer than two weeks after the procedure. CONCLUSION: Endoscopic membranectomy of duodenal membranes is a safe and effective procedure that reduces surgical times, postoperative fasting times and the length of hospitalization, and probably has no postoperative complications.