Glycopyrrolate for Anastomtic Dehiscence in Esophageal Atresia
The study was a prospective randomized control trial studying the effect of glycopyrolate on patients that had leak after esophageal atresia repair
Host summaryTodd Ponsky summarizes what Dr. Abdul Raoof Lamoshi said — not the host's own clinical position0:08 ↗
There were 297 patients over a 10 year period that underwent esophageal atresia repair
Host summaryTodd Ponsky summarizes what Dr. Abdul Raoof Lamoshi said — not the host's own clinical position0:08 ↗
Of the 297 patients, there were 42 leaks, approximately 14%
Host summaryTodd Ponsky summarizes what Dr. Abdul Raoof Lamoshi said — not the host's own clinical position0:08 ↗
The 42 patients with leaks were prospectively randomized into two groups of 21 each, one receiving glycopyrrolate and the other receiving placebo (saline)
Host summaryTodd Ponsky summarizes what Dr. Abdul Raoof Lamoshi said — not the host's own clinical position0:08 ↗
The observer was blinded to which treatment group the patient was in
Host summaryTodd Ponsky summarizes what Dr. Abdul Raoof Lamoshi said — not the host's own clinical position0:08 ↗
Chest tube output was 124 mL in the glycopyrrolate treatment group compared to 370 mL in the placebo group
Host summaryAbdul Raoof Lamoshi summarizing a resource — not the host's own clinical position1:04 ↗
Leak resolution was accomplished in 76% of the glycopyrrolate treatment group compared to 29% of the placebo group
Host summaryAbdul Raoof Lamoshi summarizing a resource — not the host's own clinical position1:04 ↗
Oral feeding was achieved in 71% of the glycopyrrolate treatment group compared to only 14% of the placebo group
Host summaryAbdul Raoof Lamoshi summarizing a resource — not the host's own clinical position1:04 ↗
The study was a very well done randomized controlled trial with a very good sample size
opinionAbdul Raoof Lamoshi1:43 ↗
The results were both statistically and clinically significant
opinionAbdul Raoof Lamoshi1:43 ↗
Glycopyrrolate is a novel treatment that can have substantial effect on the complicated problem of anastomotic leak after esophageal atresia repair
opinionTodd Ponsky1:56 ↗
TEF Presentations (Extended): Aerodigestive & Esophageal Surgery
The bugbee cautery is useful and underutilized among general surgeons for treating recurrent tracheoesophageal fistulas.
opinionTodd Ponsky0:04 ↗
A 70-degree endoscope is a difficult tool to use but useful for tracking down hard-to-find tracheoesophageal fistulas.
clinical0:37 ↗
Routine bronchoscopy is now standard practice for all type C esophageal atresia cases, though this represents a change from earlier training when it was not necessarily performed.
clinicalDan1:13 ↗
General surgeons may underappreciate tracheomalacia or laryngomalacia, making collaboration with ENT colleagues valuable for comprehensive airway assessment.
opinionTodd Ponsky1:53 ↗
Pediatric surgery fellows at this institution complete a one-month attachment with ENT to perform bronchoscopies as part of their training.
clinical2:22 ↗
Dual scoping (simultaneous bronchoscopy and esophagoscopy) is enormously valuable for complicated TEF patients, providing different information and advantages in visualization.
clinicalDan6:41 ↗
During dual scoping, you can see the light from one scope through the epithelium, inject material that may come through subtle holes, or observe bubbles from air insufflation, making simultaneous visualization quite valuable.
clinicalPhil7:33 ↗
For combined bronchoscopy and esophagoscopy in small children, a 2.8 mm flexible bronchoscope is typically used alongside an infant gastroscope (5.4 or 6 mm outer diameter).
clinicalPhil8:19 ↗
An infant gastroscope will fit retrograde through a 16 French gastrostomy tube.
clinicalPhil8:36 ↗
The concept of endoscopic TEF repair is to demucosalize the tract because mucosa is a non-stick surface; you want raw against raw with a tiny bit of fibrin glue to seal it while it scars off.
clinical11:01 ↗
When using fibrin glue for TEF repair, use a very small amount (about 0.1 ml) via a Duplo double-lumen catheter to avoid forming a foreign body.
clinical11:36 ↗
Trichloroacetic acid (TCA) can be used for TEF demucosalization, but it is difficult to control precisely and leaves white tissue everywhere, whereas the bugbee provides more precise control.
clinicalTodd Ponsky12:21 ↗
When using bugbee cautery for TEF repair, place something in the esophagus (such as an endotracheal tube) as a spacer to avoid burning the back of the esophageal wall.
clinical13:36 ↗
A bugbee catheter will go down an EGD scope, allowing cauterization from the esophageal side if the tract angle is favorable.
clinical14:29 ↗
A 3 French bugbee fits through a 2.8 mm flexible bronchoscope with a 1.2 mm suction channel, providing precise control of the tip.
clinicalBob Wood15:10 ↗
When passing a bugbee through a rigid scope, bending the end at a slight angle before insertion allows steering by rotation.
clinical15:32 ↗
Endoscopic TEF repair often needs to be performed more than once; the average is approximately 2 procedures, with some requiring 1 and others 3-4 attempts.
clinical22:37 ↗
The success rate for endoscopic TEF closure is running about 80%, not 100%.
clinical24:18 ↗
After 3 or 4 failed endoscopic TEF repair attempts, it is typically time to give up and discuss alternative approaches.
clinical24:27 ↗