Fetoscopic Endoluminal Tracheal Occlusion and Reestablishment of Fetal Airways for Congenital Diaphragmatic Hernia

Overview

Journal Gynecol Surg

Specialty Gastroenterology

Date 2018 May 18

PMID 29770109

Citations 25

Authors

Lennart Van der Veeken

Francesca Maria Russo

Luc De Catte

Eduard Gratacos

Alexandra Benachi

Yves Ville

Kypros Nicolaides

Christoph Berg

Glenn Gardener

Nicola Persico

Pietro Bagolan

Greg Ryan

Michael A Belfort

Jan Deprest

Affiliations

Soon will be listed here.

Abstract

Background: Congenital diaphragmatic hernia (CDH) is a congenital anomaly with high mortality and morbidity mainly due to pulmonary hypoplasia and hypertension. Temporary fetal tracheal occlusion to promote prenatal lung growth may improve survival. Entrapment of lung fluid stretches the airways, leading to lung growth.

Methods: Fetal endoluminal tracheal occlusion (FETO) is performed by percutaneous sono-endoscopic insertion of a balloon developed for interventional radiology. Reversal of the occlusion to induce lung maturation can be performed by fetoscopy, transabdominal puncture, tracheoscopy, or by postnatal removal if all else fails.

Results: FETO and balloon removal have been shown safe in experienced hands. This paper deals with the technical aspects of balloon insertion and removal. While FETO is invasive, it has minimal maternal risks yet can cause preterm birth potentially offsetting its beneficial effects.

Conclusion: For left-sided severe and moderate CDH, the procedure is considered investigational and is currently being evaluated in a global randomized clinical trial (https://www.totaltrial.eu/). The procedure can be clinically offered to fetuses with severe right-sided CDH.

Citing Articles

Fetoscopic endoluminal tracheal occlusion (FETO) and bilateral congenital diaphragmatic hernia.

Khawash A, Kronfli R, Arasu A, Gandhi R, Nicolaides K, Greenough A Case Rep Perinat Med. 2025; 12(1):20230010.

PMID: 40041268 PMC: 11616979. DOI: 10.1515/crpm-2023-0010.

Fetoscopic Endoluminal Tracheal Occlusion-Synergic Therapies in the Prenatal Treatment of Congenital Diaphragmatic Hernia.

Bara Z, Gozar H, Nagy N, Gurzu S, Derzsi Z, Forro T Int J Mol Sci. 2025; 26(4).

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Fetoscopic Tracheal Occlusion for Isolated Severe Left Diaphragmatic Hernia: A Systematic Review and Meta-Analysis.

Provinciatto H, Barbalho M, Araujo Junior E, Cruz-Martinez R, Agrawal P, Tonni G J Clin Med. 2024; 13(12).

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Thoracic Biometry in Patients with Congenital Diaphragmatic Hernia, a Magnetic Resonance Imaging Study.

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