Welcome to Esophageal Atresia Care at Columbia
Esophageal atresia/tracheoesophageal fistula (EA/TEF) is a rare birth defect occurring 1 in 2,500-4,000 babies where the esophagus fails to connect the mouth to the stomach. Babies with this condition must undergo surgical repair, usually shortly after birth. Without treatment, feeding may lead to milk and stomach acid getting into the trachea and lungs.
Our team at Columbia University Irving Medical Center/New York-Presbyterian Morgan Stanley Children’s Hospital offers comprehensive care to children with EA/TEF.
- This process may begin during pregnancy, with prenatal counseling if the diagnosis is made during an ultrasound.
- Patients born with EA/TEF frequently require immediate surgical intervention. Our surgeons offer minimally invasive surgical techniques whenever possible.
- Many children are born with other associated anomalies and our expert team offers multidisciplinary approaches to ensure delivery of the best possible care and outcome.
We are dedicated to improving care for children with EA/TEF through an evidence-based approach and offer many novel diagnostic and therapeutic options.
Make an appointment or learn more about how we can help by calling 212-342-8585.
Esophageal atresia (EA) is a rare congenital condition (present at birth) in which the esophagus fails to connect to the stomach as it should and ends in a blind pouch instead. Some babies have a hole between the trachea and esophagus, called a trachehoesophageal fistula, or TEF. These conditions can occur separately or together and may vary in severity, but babies with EA, TEF, or EA-TEF must undergo surgical repair as soon as possible upon birth. Without treatment, attempting to eat could cause babies to aspirate milk and stomach acid into the trachea and lungs.
Causes of esophageal atresia are not fully understood. Some children are born with EA as part of a larger syndrome of heart and or digestive tract disorders, while others have EA without these additional problems.
Signs and Symptoms
Babies born with esophageal atresia have symptoms including:
- Cyanosis – bluish tint to the skin – during attempted feeding
- Coughing and choking with attempted feeding
- Poor feeding
Suspected esophageal atresia may be diagnosed through several steps.
During pregnancy, excess amniotic fluid appearing during ultrasound may signal EA. After birth, EA may be suspected if the baby chokes, coughs, and turns blue when attempting to eat. The baby’s physician will attempt to pass a feeding tube through the baby’s mouth or nose. X-ray imaging will show whether the tube reaches the stomach or if it is coiled in the upper esophagus, indicating EA.
Babies with EA, TEF, or EA-TEF must undergo surgical repair, often very soon after birth. Without treatment, attempting to eat could cause babies to aspirate milk and stomach acid into the trachea and lungs. Surgery is successful in the vast majority of children.
The Esophageal Atresia Clinic at NewYork-Presbyterian/Columbia uses a minimally invasive surgical approach for EA repair, using three small incisions in the chest, whenever possible. After surgery, the multidisciplinary team provides long-term follow-up in order to prevent and treat acid reflux, which affects many children after EA surgery, and to ensure optimal care as children mature into adulthood.
Associated Anomalies/Birth Defects
The collaborative format of the EA program also addresses an important need for patients and their families: the need to see multiple specialists for complicated, multi-system birth defects in the spectrum known as VACTERL (Vertebral anomalies, Anal atresia, Cardiac defects, Tracheoesophageal fistula and/or Esophageal atresia, Renal & Radial anomalies and Limb defects).
EA/TEF commonly appears with the following anomalies/ birth defects:
- Heart defects such as ventricular septal defects or Tetralogy of Fallot
- Defects with the gastrointestinal system and urogenital tract such as imperforate anus
- Neurological and musculoskeletal defects
Elsewhere, parents must bring their children to individual specialists for care of these problems, but the collaborative team at NewYork-Presbyterian Morgan Stanley Children’s Hospital includes the range of experts so that a child may see multiple specialists in a single visit, rather than making multiple separate trips.
William Middlesworth, MD
Surgical Director of the Esophageal Atresia Program
Julie Khlevner, MD
Medial Director of the Esophageal Atresia Program
Make an appointment with our team by calling 212-342-8585.
The Research in Esophageal Atresia for Children’s Health (REACH) Clinic at Columbia was founded with the following goals in mind:
- Providing coordinated multidisciplinary care that addresses all facets of a child’s conditions
- Determining how to safely and effectively treat silent reflux and other complications associated with EA
- Helping older patients transition to practitioners caring for adults who are well versed in the special needs associated with EA
- Conducting research to identify genetic abnormalities underlying EA and related anomalies
- Conducting longitudinal clinical research in order to develop best-practice treatment protocols.
Current Research Projects
Our ongoing research focuses on three main areas:
- To identify gene mutations that will help us better understand development of EA/TEF and its associated defects and serve as a target for future therapeutic modality.
- To identify the best practice guidelines for this patient population
- To identify the best treatment and surveillance plan that will optimize esophageal function, minimize esophageal injury and avoid unnecessary treatment using a multidisciplinary care approach.
- Singh A, Middlesworth W, Khlevner J. Surveillance in Patients with Esophageal Atresia. Curr Gastroenterol Rep. 2017 Jan;19(1):4
- Khlevner J, Middlesworth W, Wang J, et al. “Novel Candidate Genes in Esophageal Atresia/Tracheoesophageal Fistula Identified by Whole Exome Sequencing” Digestive Disease Week (DDW) June 2018, National Annual meeting. Washington DC
- Hawks C, Middlesworth W, Khlevner J. " Do Symptoms Reliably Identify Esophageal Stricture in Patients with Esophageal Atresia?” The North American Society of Pediatric Gastroenterology, Hepatology and Nutrition. National Annual Meeting. November 2017. Las Vegas, NV
- Suchy H, Middlesworth W, Khlevner J. “Correlation between multichannel intraluminal impedance/pH monitoring and esophageal biopsy for esophageal surveillance in children with esophageal atresia.” The North American Society of Pediatric Gastroenterology, Hepatology and Nutrition National Annual Meeting. October 2015. Washington, DC
For an initial consultation at our multidisciplinary EA/TEF clinic, please contact Marie Coreless at 212-342-8585.
Please click to download our various educational resources for parents:
REACH Clinic Information Sheets:
- Upper Endoscopy Diagnostic Testing
- Esophageal Dilation Diagnostic Testing
- Impedance pH Probe Diagnostic Testing