What causes tracheoesophageal fistula (TEF)?

Updated: Nov 07, 2018
  • Author: Sat Sharma, MD, FRCPC; Chief Editor: Vinay Kumar Kapoor, MBBS, MS, FRCS, FAMS  more...
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Although no definite cause exists for congenital tracheoesophageal fistulas (TEFs), an association with trisomies 18, 21, and 13 has been reported. In addition, the use of decongestants that contain imidazoline derivatives by women during the first trimester of pregnancy has been linked to an increased risk for congenital TEFs. [2]

Causes of acquired TEFs include iatrogenic injury, blunt chest or neck trauma, prolonged mechanical ventilation via endotracheal or tracheostomy tube, and excessive tube cuff pressure in patients ventilated for lung disease. There has even been a case report of an impacted denture causing TEF. [3]

Spigel et al investigated the development of TEFs in patients with small-cell and non-small-cell lung cancer. They reported their findings from 2 small, independent phase II clinical trials in which patients were administered bevacizumab combined with chemotherapy and radiation. [4] Both trials were closed early for safety reasons. However, the data suggested an association between the use of bevacizumab and chemoradiotherapy and a relatively high incidence of TEFs in the settings of small-cell and non-small-cell lung cancer. [4]

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