Clinical insights and management outcomes of tracheoesophageal and bronchoesophageal fistulas: a 20-year case series review

Abnormal connections between the trachea and esophagus, known as tracheoesophageal fistula (TEFs) and bronchoesophageal fistula (BEFs), are uncommon but potentially life-threatening conditions that can result in severe complications. This study aimed to explore the anatomical features, underlying causes of TEF and BEF and evaluate the treatment efficacy. This retrospective study reviewed 15 cases of TEF/BEF treated at the University Hospital from 2001 to 2020. It examines the anatomical features, underlying causes, and treatment outcomes of these fistulas and evaluates various treatment modalities, such as open surgery, tracheal and esophageal stenting, and gastrostomy/jejunostomy. This study included 15 patients (aged 15–65 years). Most cases were non-malignant (80%), mainly due to post-intubation injuries, while 20% were associated with malignancies, such as lymphoma and esophageal cancer. The fistulas were mostly located in the mid-trachea, with 40% measuring 1–3 cm. Gastrostomy/jejunostomy is the most common treatment option, particularly in malignant cases. The morbidity rate was 46.7%, with tracheal stenosis being the most frequent complication and no deaths reported. Follow-up (1–23 months) showed significant improvement in benign TEFs but no improvement in malignant TEFs. This study highlights the challenges in managing TEF/BEF and advocates treatment plans tailored to the specific etiology and characteristics of the fistula. These findings contribute to the limited existing literature on acquired TEF/BEF, suggesting that a multidisciplinary approach is essential for optimizing patient outcomes in these complex cases.