Microsoft Word - IJHHS IMAM 23rd ASC 2022


  
 

 S29

A Novel Bedside Diagnostic Technique for Acquired Tracheoesophageal Fistula 
 
Nesha Rajendram1,2, Muhammad Ariff Sobani2, Masaany Mansor1,2, Intan Kartika Kamarudin1,2,, 
Norazila Abdul Rahim1,2   
  
Acquired tracheoesophageal fistula is a rare and challenging medical dilemma. In general, 
tracheoesophageal fistula (TOF) is diagnosed by subjecting a patient to imaging such as barium swallow 
or computed tomography of the neck and thorax. The patient may need a diagnostic bronchoscopy under 
general anaesthesia and flexible oesophagoscopy. We report three cases of suspected TOF diagnosed 
utilising a new, novel, minimally invasive, an office-based procedure in a bedside setting. TOF is 
difficult to diagnose. Our technique is practical, utilizes instruments in the clinic itself, is comfortable 
for the patient, and is inexpensive.  

The cases include a post tracheostomised patient who was suspected to be complicated with 
TOF, a patient who underwent OGDS for investigation of dysphagia and odynophagia with an 
incidental finding of oesophageal fistula, and a patient who underwent anterior cervical corpectomy and 
fusion with an open tracheostomy, who was suspected to have an oesophageal fistula post neck 
surgery.   

The technique used a flexible nasopharyngolaryngoscope (FNPLS), and a nasogastric tube 
instilled with methylene blue and local anaesthesia into the larynx and trachea in an awake patient. The 
detailed step-by-step procedure was described. This technique is simple and safe. It eliminates the need 
to subject patients to general anaesthesia or contrasted imaging in diagnosing TOF.  
  
Keywords: tracheoesophageal fistula, oesophageal fistula; methylene blue; office-based procedure  
 

1. Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, 
Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia  
2. Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Al Sultan 
Abdullah UITM, Puncak Alam, Malaysia  

  

 

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Correspondence to:  

Intan Kartika Kamarudin, Senior Lecturer and Otorhinolaryngology Head and Neck Surgeon, 
Department of Otorhinolaryngology Head and Neck Surgery, Universiti Teknologi MARA, Malaysia, 
kartika@uitm.edu.my 

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DOI: http://dx.doi.org/10.31344/ijhhs.v7i70.531