Crucial bronchoscopic findings in esophageal atresia and tracheoesophageal fistula.

We performed a brief bronchoscopy in 42 newborn infants with esophageal atresia and tracheoesophageal fistula (TEF). The procedure was carried out in the operating room, usually just prior to thoracotomy for repair of the anomaly. Most infants had a gastrostomy tube placed initially. Observations included: (1) level of fistula, (2) presence of unusual variants, eg, double fistula, trifurcation fistula, (3) presence and severity of tracheobronchitis, and (4) position of the aortic arch. The endoscopic findings influenced the operative technique or management of 24 of the 42 infants (57%), including 13 infants (31%) with crucial findings which dictated a change in operative technique or management. Examples of the latter were an unsuspected cervical fistula associated with esophageal atresia, repaired by a cervical approach; other unusual variants of TEF (proximal fistula, trifurcation or quadrifurcation TEF), requiring specific dissection at thoracotomy; congenital stenosis of the right mainstem bronchus, requiring postoperative dilatation; or severe tracheobronchitis, which contraindicated thoracotomy. Observations at bronchoscopy accurately predicted the position of the aortic arch in ten recent infants, although the side of dominant pulsation was indeterminate in three other infants. Only one minor complication was attributable to the bronchoscopy. The procedure appeared to be safe and beneficial, and should be considered for all infants with esophageal atresia and TEF.