A Novel Bedside Diagnostic Technique for Acquired Tracheoesophageal Fistula

Author: Intan Kartika Kamarudin


Intan Kartika Kamarudin (Dr ORL-HNS), Nesha Rajendram MBBS, Muhammad Ariff Sobani MBBS, Masaany Mansor (Ms ORL-HNS), Norazila Abdul Rahim (Ms ORL-HNS)

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, office-based procedure in a bedside setting. TOF is difficult to diagnose. Our technique is practical, utilizes instruments in the clinic itself, is comfortable to the patient, and inexpensive.

     The cases include 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 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 is described. This technique is simple and safe. It eliminates the need to subject patient to general anaesthesia or contrasted imaging in diagnosing TOF.


Keywords : tracheoesophageal fistula, oesophageal fistula;methylene blue; office-based procedure

(203 words)

  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


Correspondence to: 

Intan Kartika Kamarudin , Lecturer and Otorhinolaryngology Head and Neck Surgeon, Department of Otorhinolaryngology Head and Neck Surgery, Universiti Teknologi MARA, Malaysia , [email protected]