Flexible Endoscopy (FE)
Flexible endoscope with an out-diameter of 2.6 mm and working length of 30 cm (ENF-V3, Olympus) was introduced via patient’s nose (left) and advanced to aeroesophageal tracks for inspection. Nose-closure maneuver with SPI duration of 2-5 seconds was performed to gradually expand the associated lumens in order to facilitate a complete and dynamic evaluation. FE assessed the structures in following order: pharynx, larynx, trachea, TEF, bilateral bronchi, lower esophagus, stomach, then withdrew back to pharynx and went to upper esophagus. Commonly associated anatomic anomalies such as TM, fistula and upper esophageal pouch were clearly identified. The fistula location and opening width were estimated with FE. The distance from the upper edge of the carina to the lower edge of fistula was measured using the FE tip technique.