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.