The International Network on Oesophageal Atresia (InNoEA) Consensus Guidelines on the Transition of Patients With Oesophageal Atresia-Tracheoesophageal Fistula
Nature Reviews Gastroenterology & Hepatology
Krishnan, U., Dumont, M. W., et al. (2023).
Nature Reviews Gastroenterology & Hepatology, 20(11), 735-755.
<div>This clinical practice guideline provides recommendations for assessing and treating patients with esophageal atresia-tracheoesophageal fistula (EA-TEF) during adolescence and adulthood. While this guideline contains recommendations for a wide variety of practitioners, this article summary only contains recommendations within the scope of speech-language pathology (SLP). </div>
International Network on Oesophageal Atresia (INoEA)
<div>In adults, swallowing dysfunction is common following EA-TEF repair. Any worsening dysphagia should prompt a swallowing evaluation.</div>
<div>Adult patients with EA-TEF with worsening respiratory status should be investigated for aspiration. Aspiration may occur due to many causes, including esophageal dysfunction, recurrent TEF and reflux, tracheomalacia, laryngeal cleft, or classical asthma. Testing may include an objective swallow assessment and other instrumental evaluations (i.e., upper gastrointestinal series, bronchoscopy, upper endoscopy, pH-impedance testing, pulmonary function testing with a bronchodilator response).</div>
<div>Therapeutic strategies to reduce the incidence of malnutrition in adolescent and adult patients with EA-TEF may include "follow-ups in a multidisciplinary clinic, monitoring of growth and nutrition, adapting and tailoring of textural quality of foods, supplemental enteral nutrition with feeding tubes and gastrostomy when indicated, and awareness of risk for eating disorders and psychosocial factors" (p. 748). However, there is currently no available research on the efficacy of modified diets in improving dysphagia and feeding in this population.</div>
<div>When transitioning into adulthood, all adolescents with EA-TEF should be seen by a dietitian and swallow specialist. They should be routinely screened for nutritional deficits and swallowing difficulties, especially for individuals with concerns regarding their growth and dietary intake. Adults with EA-TEF ideally should be monitored annually by a dietitian and swallowing specialist.</div>
<div>Optimal transition preparation of adolescents with EA-TEF and their parents should include the following:</div>
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<li>a transition approach that is strength-based and patient and family-centered that enables the patient to contribute to decision-making;</li>
<li>targeted and individualized education to increase patient knowledge of EA-TEF, including risk factors;</li>
<li>the active development of health-care self-management skills, as appropriate;</li>
<li>dedicated support for parents to transition from the role of health-care manager to health-care guide, as appropriate;</li>
<li>holistic care to meet the medical, educational, vocational and psychosocial needs of adolescents with EA-TEF;</li>
<li>the clear designation of a transition lead to facilitate coordinated care across both the pediatric and adult health-care settings; and</li>
<li>collaboration and discussion across pediatric and adult health-care teams to ensure a supported and seamless transfer of care.</li>
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