Comprehensive Insights into Tracheoesophageal Fistula Pathophysiology, Diagnosis, Treatment, and Future Directions

Abstract Tracheoesophageal fistula (TEF) represents a pathological connection between the trachea and esophagus, classified into congenital and acquired categories. Congenital TEF arises from embryological malformations, often coexisting with esophageal atresia (EA), while acquired TEF primarily stems from malignancies, radiotherapy, or trauma. This condition disrupts normal anatomical functions, leading to significant clinical issues, such as aspiration, respiratory infections, and malnutrition. The current review consolidates findings on the etiology, classification, and pathological mechanisms of TEF, emphasizing how genetic, developmental, and external factors shape its occurrence and progression. Diagnostic advancements, including radiological imaging, endoscopic evaluations, and newer monitoring techniques, have refined clinical assessment. Treatment paradigms for TEF vary from minimally invasive endoscopic interventions, to traditional open and innovative surgical approaches. Conservative management, such as nutritional and anti‐infective therapies, remains vital, especially for milder cases. Emerging therapies in regenerative medicine—such as tissue‐engineered scaffolds and platelet‐rich plasmaoffer transformative potential for refractory cases. Future advancements are oriented toward exploring 3D printing, artificial intelligence, and precision medicine. The necessity of multidisciplinary collaboration is underscored in optimizing holistic patient care. While significant progress has improved cure rates and long‐term outcomes, continued research on innovative technologies and clinical trials addressing knowledge gaps in long‐term efficacy remains crucial.