Aims
To describe real-world outcomes of endoscopic management of Tracheo-Esophageal Fistula(TEF) across varied etiologies and to suggest a practical, algorithm-based approach to intervention selection.
Methods
We present a retrospective series of 15 consecutive TEF cases managed at Yashoda Hospital, Secunderabad, India, a tertiary care centre, seen from December 2022 till November 2025.
Results
We hereby share our experience of 15 cases of TEF. According to the etiology, two main groups have been identified- Malignant and Benign causes of TEF.
- Malignant TEF (n=6) due to Carcinoma Esophagus: All underwent partially covered esophageal SEMS placement, achieving good technical and clinical success.
- Benign Causes of TEF (n=9): According to the etiology again, 3 subgroups were identified:
i) Post-intubation TEF (n=4):
• ASD closure device placement: 2 patients (successful).
• Tracheal stent + OTSC: 1 patient (successful).
• OTSC alone: 1 patient (partial dislodgement at 2 months → PEG for feeding; planned surgery).
ii) Tracheostomy Tube-related TEF-Post thyroid cancer laryngectomy (n=2):
• ASD closure device placement: 1 successful case.
• Cervical covered SEMS: 1 case with stent-related erosion → stent removal → spontaneous healing of Erosion over 2 weeks; PEG-J feeding provided.
iii) Tuberculosis-related TEF (n=3):
a) Small defect: Anti Tuberculosis Therapy(ATT)+ NG feeding, successful.
b) Larger defects:
• Esophageal covered stent + proximal clipping of stent (1 case), clinically successful.
• APC margin cauterization + multiple hemoclips (1 case), successful.
Overall, endoscopic therapy for TEF in our series demonstrated high technical and clinical success across varied etiologies. We recommend the following approach to the management of this complex disorder.
Suggested Algorithm for TEF Management
| 1. Confirm Diagnosis: Imaging, Scopies, Characterise- Size, location, cause |
| 2. Airway Management +/- Airway Stenting |
| 3. Nutrition management and Assess fitness for Surgery |
| 4. Endoscopic Options |
| Malignant TEF | Benign TEF |
|---|---|
| Esophageal SEMS +/- Tracheal Stenting | Defect <5mm: Clipping+/- APC of edges |
| 5-10mm: OTSC/ ASD Closure Device | |
| 10-12 mm: ASD Closure Device/ EndoSuture | |
| >12 mm: Dual Stenting/ Surgery | |
| Defect >15mm: Surgery |
Conclusions
Tracheo Esophageal Fistula(TEF) is a complex entity requiring a multidisciplinary, individualized approach. Endoscopic therapy—particularly stenting—remains the cornerstone for malignant TEF, while benign TEF may benefit from tailored interventions including clipping, cauterization or device closure. Larger defects may require surgical intervention. Our experience with good number of cases suggests that endotherapy offers favorable outcomes when guided by defect characteristics, patient condition and an algorithmic treatment strategy.