SURGICAL correction of congenital tracheoesophageal fistula without esophageal atresia (H-type) is dependent upon adequate demonstration of the fistula. Despite an increasing awareness of the anomaly and numerous attempts at diagnosis by conventional techniques, the fistula often is not demonstrated until repeated episodes of aspiration pneumonia have occurred. Schneider and Becker1 reviewed the results obtained with various techniques for diagnosis and concluded that cinefluororadiography offered the best chance for confirming the presence of a suspected tracheoesophageal fistula. Even with this method the diagnosis may be inconclusive because of spillover of contrast material from the esophagus into the trachea during swallowing.
Because of the difficulty in establishing the diagnosis, the fistula has been demonstrated in a number of children only by operation or at autopsy.2,3 Swenson4 and Killen2 have recommended the use of a forward-viewing cystoscope for performance of tracheoscopy when an H-type tracheoesophageal fistula is suspected. It