Esophageal Atresia Diagnosis, Need for Better Options Lead NY Families to UMPhysicians Specialist

What would you do if you were told your child would probably never eat normally and would have a feeding tube in his or her stomach for life?

When their first baby, Christopher, was born with esophageal atresia (EA), Cathy and Chris Meehan, of New Hyde Park, N.Y., searched the Internet for answers. Vivianne and Peter Cardillo, of Brooklyn, N.Y., searched the medical community for a second opinion when one of their twins, Thomas, was diagnosed with EA. Christine and Michael LoGiudice, of Long Island, sought another opinion after an attempt at surgical repair in New York failed on their baby, Michael.

All three families found John Foker, M.D., through different means, but they have all since reached the same conclusion: the pioneer pediatric cardiothoracic surgeon from University of Minnesota Children’s Hospital, Fairview, changed their babies’ lives in a way no one else could. He gave them hope and, more importantly, he gave them results.

During fetal development, the esophagus and trachea arise virtually from the same tissue bud and form into two side-by-side passageways. The esophagus leads from the throat to the stomach and digestive tract, and the trachea forms the airway between the larynx and the lungs. In the case of EA, the esophagus develops incorrectly and ends in a blind pouch in the neck instead of connecting to the stomach, and saliva and food cannot be swallowed. The combination of EA with or without a connection to the trachea (called tracheoesophageal fistula, or TEF) prevents effective swallowing, and saliva pools in the mouth, compromising breathing and creating a life-threatening condition.

EA occurs in approximately one in 3,000 births. About five to 20 of these babies nationally undergo surgery each year.

In the majority of cases, joining the ends of the esophagus is straightforward. In 20-25 percent of EA patients, however, the ends are so far apart they can’t easily be connected. The situation for the three New York children was even more serious. In each, all the esophagus from the neck to the diaphragm was missing.

To solve the problem of the missing esophagus, Foker developed a technique to stimulate the little blind upper and lower ends of the esophagus to grow so they could be joined together. Traction sutures are placed in the tiny esophageal ends and the tension increased daily. For the three boys, the ends rapidly grew. Even when no esophagus was present in the chest, within about two weeks, the ends had grown and could be joined together.

“Doctors elsewhere are trying to replicate Dr. Foker’s method, but they haven’t perfected it like he has. That’s why we wanted to come here,” says Vivianne Cardillo, who is also a nurse.

All babies with EA/TEF require surgery to correct the condition and allow proper eating and swallowing. Many different operations are used and sometimes performed in separate stages over several years. Foker’s patients usually have two to three growth operations over a one- to three-week period, often followed by an anti-reflux procedure. Over a span of three to six months, the children often learn to eat and may have their feeding tubes removed. All of Foker’s patients—about 50 in the past 10 years—are on track to eat and swallow like other children.

“The entire EA team is driven by the mission of giving these kids the expectation of a normal life,” says Foker. “There are many members of the University of Minnesota Children’s Hospital community who justifiably take great pride in the success of the EA team.”

The LoGiudices’ son Michael is making progress and nearly ready to eat real food. “We have met so many other parents whose kids have already had this procedure by Dr. Foker. They’re now eating normally and healthy and, best of all, they had no recollection of the operations,” says Christine. “We still have some catching up to do, but we are looking forward to that day, and we know it’s within reach.”

Doctors in New York gave Cathy and Christopher Meehan a 50/50 chance of success if they had the operation there. “We had to give Christopher a better shot than 50/50,” says Cathy. “In our very first conversation with Dr. Foker, he said, ‘Failure is not an option.’ When things seemed hopeless for us and for Christopher, he took that horrible feeling away. So we had no choice but to come to Minnesota and stay under the care of Dr. Foker. We love that man.”

The Meehans are impressed with the care they received at the children’s hospital. “It’s amazing here. People are nice and the place runs very smoothly,” says Cathy. “Nothing compares to the University of Minnesota Children’s Hospital.”