Recurrent TEFs occur in 5-10% of cases after primary repair, as a result of esophageal anastomotic leak, trauma from esophageal dilatations and/or airway infections95–102. The manifestations of recurrent TEF are potentially severe and include cough, choking and cyanosis during feeds, and recurrent pneumonias. Diagnosis is challenging and often delayed despite multiple investigations. There was strong agreement that recurrent TEFs are best diagnosed with simultaneous esophageal endoscopy and bronchoscopy, aided by the infusion of methylene blue on the tracheal or esophageal side and observing its appearance on the other side98,103. An esophagogram in prone or semi-prone position with contrast administered under pressure can be diagnostic and has the fewest false negative results (compared with upper GI in supine or erect positions), but it may miss a TEF in the presence of an esophageal stricture95,97,104,105. Moreover, it is not a standard technique among radiologists, and therefore did not receive strong recommendation. This multidisciplinary approach is increasingly used to optimise outcomes in children with recurrent TEF106,107.