The Esophageal and Airway Treatment (EAT) Program at Johns Hopkins All Children’s Hospital is dedicated to research and innovation that improves health care outcomes.

Research is central to our mission to improve outcomes for children with complex esophageal, airway and thoracic conditions in the Esophageal and Airway Treatment Program at Johns Hopkins All Children’s. We maintain a database to closely track short-term and long-term clinical outcomes and are also helping develop a national database registry to track and standardize outcomes across the United States.

Some of our other research efforts include:

• We are continually developing innovative treatments for esophageal and airway conditions. This includes developing and assessing the Tapering Membrane Reduction Tracheobronchoplasty (TMRT) to treat severe tracheobronchomalacia as part of a multicenter study, work to develop external splint devices to support the trachea in patients with severe tracheobronchomalacia, new techniques for recurrent nerve reconstruction, innovative minimally invasive techniques to treat vascular rings, and subglottic stenosis reconstruction techniques.
• Our program is part of a consortium of esophageal referral programs studying the use of magnet-based esophageal growth and anastomosis for cases involving long gap esophageal atresia and severe esophageal strictures.
• We are involved in a clinical trial evaluating when tracheostomy can be safely avoided in infants with bronchopulmonary dysplasia and tracheomalacia.
• We are working with other institutions on research related to esophageal replacement, reconstruction to treat injury from caustic ingestion, and treatment for cystic fibrosis patients who have tracheomalacia.
• We are working to teach other providers how to better diagnose tracheobronchomalacia, which is frequently mistaken for asthma or recurrent croup.
• We are developing an AI-enabled dashboard to analyze patient outcomes, with the goal of identifying patterns and improving data interpretation in real time.

Select Publications

Tracheobronchopexy/tapering membrane reduction tracheobronchoplasty

• Shieh HF, Smithers CJ, Hamilton TE, Zurakowski D, Rhein LM, Manfredi MA, Baird CW, Jennings RW. Posterior tracheopexy for severe tracheomalacia. J Pediatr Surg. 2017 Jun;52(6):951-955. doi: 10.1016/j.jpedsurg.2017.03.018. Epub 2017 Mar 18. PMID: 28385426.
• Shieh HF, Smithers CJ, Hamilton TE, Zurakowski D, Visner GA, Manfredi MA, Baird CW, Jennings RW. Posterior tracheopexy for severe tracheomalacia associated with esophageal atresia (EA): primary treatment at the time of initial EA repair versus secondary treatment. Front Surg 2018; 4:80.
• Kamran A, Hamilton TE, Zendejas B, Nath B, Jennings RW, Smithers CJ. Minimally Invasive Surgical Approach for Posterior Tracheopexy to Treat Severe Tracheomalacia: Lessons Learned from Initial Case Series. J Laparoendosc Adv Surg Tech A. 2018 Dec;28(12):1525-1530. doi: 10.1089/lap.2018.0198. Epub 2018 Jul 5.PMID: 29975595
• Shieh HF, Smithers CJ, Hamilton TE, Zurakowski D, Visner GA, Manfredi MA, Jennings RW*, Baird CW*. Descending aortopexy and posterior tracheopexy for severe tracheomalacia and left mainstem bronchomalacia. Semin Thorac Cardiovasc Surg 2019; 31(3): 479-485.
• Lawlor C, Smithers CJ, Hamilton T, Baird C, Rahbar R, Choi S, Jennings R. Innovative management of severe tracheobronchomalacia using anterior and posterior tracheobronchopexy. Laryngoscope. 2020 Feb;130(2):E65-E74. doi: 10.1002/lary.27938. Epub 2019 Mar 25.PMID: 30908672
• Mohammed S, Kamran A, Izadi S, Visner G, Frain L, Demehri FR, Shieh HF, Jennings RW, Smithers CJ, Zendejas B. Primary Posterior Tracheopexy at Time of Esophageal Atresia Repair Significantly Reduces Respiratory Morbidity. J Pediatr Surg. 2024 Jan;59(1):10-17. doi: 10.1016/j.jpedsurg.2023.09.028. Epub 2023 Sep 22. PMID: 37903674.
• Mukharesh L, Krone KA, Hamilton TE, Shieh HF, Smithers CJ, Winthrop ZA, Muise ED, Jennings RW, Mohammed S, Demehri FR, Zendejas B, Visner GA. Outcomes of surgical treatment of tracheobronchomalacia in children. Pediatric Pulmonol 2024; online ahead of print.

Long gap esophageal atresia and the Foker process

• Shieh HF, Jennings RW. Long-gap esophageal atresia. Semin Pediatr Surg 2017; 26(2): 72-77.
• Bairdain S, Hamilton TE, Smithers CJ, Manfredi M, Ngo P, Gallagher D, Zurakowski D, Foker JE, Jennings RW. Foker process for the correction of long gap esophageal atresia: Primary treatment versus secondary treatment after prior esophageal surgery. J Pediatr Surg. 2015 Jun;50(6):933-7. doi: 10.1016/j.jpedsurg.2015.03.010. Epub 2015 Mar 25.PMID: 25841281
• Jo Svetanoff W, Zendejas B, Ngo P, Manfredi M, Hamilton TE, Jennings RW, Smithers CJ. The left-sided repair: An alternative approach for difficult esophageal atresia repair. J Pediatr Surg. 2021 May;56(5):938-943. doi: 10.1016/j.jpedsurg.2020.11.003. Epub 2020 Nov 13.PMID: 33248682
• Svetanoff WJ, Zendejas B, Hernandez K, Davidson K, Ngo P, Manfredi M, Hamilton TE, Jennings R, Smithers CJ.Contemporary outcomes of the Foker process and evolution of treatment algorithms for long-gap esophageal atresia. J Pediatr Surg. 2021 Dec;56(12):2180-2191. doi: 10.1016/j.jpedsurg.2021.02.054. Epub 2021 Feb 26.PMID: 33766420
• Shieh HF, Jennings RW, Manfredi MA, Ngo PD, Zendejas B*, Hamilton TE*. Cautionary tales in the use of magnets for the treatment of long gap esophageal atresia. J Pediatr Surg 2022; 57(10): 342-347.
• Shieh HF, Hamilton TE, Manfredi MA, Ngo PD, Wilsey MJ, Yasuda JL, Zendejas B, Smithers CJ. Evolution of left-sided thoracoscopic approach for long gap esophageal atresia repair. J Pediatr Surg 2023; 58(4): 629-632.
• Izadi S, Smithers J, Shieh HF, Demehri FR, Mohammed S, Hamilton TE, Zendejas B. The History and Legacy of the Foker Process for the Treatment of Long Gap Esophageal Atresia. J Pediatr Surg. 2023 Dec 19:S0022-3468(23)00761-3. doi: 10.1016/j.jpedsurg.2023.12.020. Epub ahead of print. PMID: 38184432.

Tracheoesophageal fistulas

• Smithers CJ, Hamilton TE, Manfredi MA, Rhein L, Ngo P, Gallagher D, Foker JE, Jennings RW. Categorization and repair of recurrent and acquired tracheoesophageal fistulae occurring after esophageal atresia repair. J Pediatr Surg. 2017 Mar;52(3):424-430. doi: 10.1016/j.jpedsurg.2016.08.012. Epub 2016 Aug 31.PMID: 27616617
• Kamran A, Zendejas B, Meisner J, Choi SS, Munoz-San Julian C, Ngo P, Manfredi M, Yasuda JL, Smithers CJ, Hamilton TE, Jennings RW.Effect of Posterior Tracheopexy on Risk of Recurrence in Children after Recurrent Tracheo-Esophageal Fistula Repair. J Am Coll Surg. 2021 May;232(5):690-698. doi: 10.1016/j.jamcollsurg.2021.01.011. Epub 2021 Feb 5. PMID: 33556502.

Esophageal strictures

• Kamran A, Smithers CJ, Manfredi MA, Hamilton TE, Ngo PD, Zurakowski D, Jennings RW. Slide Esophagoplasty vs End-to-End Anastomosis for Recalcitrant Esophageal Stricture after Esophageal Atresia Repair. J Am Coll Surg. 2018 Jun;226(6):1045-1050. doi: 10.1016/j.jamcollsurg.2017.11.020. Epub 2017 Dec 7.PMID: 29224798
• Manfredi MA, Clark SJ, Medford S, Staffa SJ, Ngo PD, Hamilton TE, Smithers CJ, Jennings RW. Endoscopic Electrocautery Incisional Therapy as a Treatment for Refractory Benign Pediatric Esophageal Strictures. J Pediatr Gastroenterol Nutr. 2018 Oct;67(4):464-468. doi: 10.1097/MPG.0000000000002008.PMID: 29697549
• Ngo PD, Kamran A, Clark SJ, Jennings RW, Hamilton TE, Smithers CJ, Zendejas B, Yasuda JL, Zurakowski D, Manfredi MA. Intralesional Steroid Injection Therapy for Esophageal Anastomotic Stricture Following Esophageal Atresia Repair. J Pediatr Gastroenterol Nutr. 2020 Apr;70(4):462-467. doi: 10.1097/MPG.0000000000002562.PMID: 31764412
• Kamran A, Smithers CJ, Izadi SN, Staffa SJ, Zurakowski D, Demehri FR, Mohammed S, Shieh HF, Ngo PD, Yasuda J, Manfredi MA, Hamilton TE, Jennings RW, Zendejas B. Surgical Treatment of Esophageal Anastomotic Stricture After Repair of Esophageal Atresia. J Pediatr Surg. 2023 Dec;58(12):2375-2383. doi: 10.1016/j.jpedsurg.2023.07.014. Epub 2023 Jul 29. PMID: 37598047.

Jejunal interposition and esophageal replacement

• Thompson K, Zendejas B, Svetanoff WJ, Labow B, Taghinia A, Ganor O, Manfredi M, Ngo P, Smithers CJ, Hamilton TE, Jennings RW. Evolution, lessons learned, and contemporary outcomes of esophageal replacement with jejunum for children. Surgery. 2021 Jul;170(1):114-125. doi: 10.1016/j.surg.2021.01.036. Epub 2021 Apr 1. PMID: 33812755.
• Bludevich BM, Kauffman JD, Smithers CJ, Danielson PD, Chandler NM. 30-Day Outcomes Following Esophageal Replacement in Children: A National Surgical Quality Improvement Project Pediatric Analysis. J Surg Res. 2020 Nov;255:549-555. doi: 10.1016/j.jss.2020.05.050. Epub 2020 Jul 5.PMID: 32640406

Aortopexy

• Jennings RW, Hamilton TE, Smithers CJ, Ngerncham M, Feins N, Foker JE. Surgical approaches to aortopexy for severe tracheomalacia. J Pediatr Surg. 2014 Jan;49(1):66-70; discussion 70-1. doi: 10.1016/j.jpedsurg.2013.09.036. Epub 2013 Oct 16. PMID: 24439583.
• Shieh HF, Smithers CJ, Hamilton TE, Zurakowski D, Visner GA, Manfredi MA, Jennings RW, Baird CW. Descending Aortopexy and Posterior Tracheopexy for Severe Tracheomalacia and Left Mainstem Bronchomalacia. Semin Thorac Cardiovasc Surg. 2019 Autumn;31(3):479-485. doi: 10.1053/j.semtcvs.2018.02.031. Epub 2018 Mar 7. PMID: 29524603.
• Svetanoff WJ, Zendejas B, Frain L, Visner G, Smithers CJ, Baird CW, Prabhu SP, Jennings RW, Hamilton TE. When to consider a posterolateral descending aortopexy in addition to a posterior tracheopexy for the surgical treatment of symptomatic tracheobronchomalacia. J Pediatr Surg. 2020 Dec;55(12):2682-2689. doi: 10.1016/j.jpedsurg.2020.04.018. Epub 2020 May 3.PMID: 32444171

Vascular rings

• Labuz DF, Kamran A, Jennings RW, Baird CW. Reoperation to correct unsuccessful vascular ring and vascular decompression surgery. J Thorac Cardiovasc Surg. 2022 Jul;164(1):199-207. doi: 10.1016/j.jtcvs.2021.08.089. Epub 2021 Nov 11. PMID: 34922756.

Endoscopic vacuum-assisted closure

• Manfredi MA, Clark SJ, Staffa SJ, Ngo PD, Smithers CJ, Hamilton TE, Jennings RW. Endoscopic Esophageal Vacuum Therapy: A Novel Therapy for Esophageal Perforations in Pediatric Patients. J Pediatr Gastroenterol Nutr. 2018 Dec;67(6):706-712. doi: 10.1097/MPG.0000000000002073.PMID: 29927863
• Barnett GS, Kimsey KM, Shieh HF, Smithers CJ, deVries JM, Mouch J, Wilsey MJ. Treatment of esophageal perforation: endoscopic vacuum-assisted closure. JPGN Rep 2023; 4(2): e314.
• Trocchia C, Shieh HF, Dolan I, Wilsey MJ, Smithers CJ. Pulling instead of pushing: a case report of gastrostomy-assisted pull technique as an alternative method for endoluminal sponge placement in E-VAC therapy. JPGN Rep 2024; 5(1): 74-78.

Anti-reflux and Nissen fundoplication

• Thompson K, Zendejas B, Kamran A, Svetanoff WJ, Meisner J, Zurakowski D, Staffa SJ, Ngo P, Manfredi M, Yasuda JL, Jennings RW, Smithers CJ, Hamilton TE. Predictors of anti-reflux procedure failure in complex esophageal atresia patients. J Pediatr Surg. 2022 Jul;57(7):1321-1330. doi: 10.1016/j.jpedsurg.2021.08.005. Epub 2021 Aug 14.PMID: 34509283

External airway splints

• Shieh HF, Jennings RW. Three-dimensional printing of external airway splints for tracheomalacia. J Thorac Dis 2017; 9(3): 414-416.
• Kamran A, Smithers CJ, Baird CW, Jennings RW. Experience with bioresorbable splints for treatment of airway collapse in a pediatric population. JTCVS Tech. 2021 Apr 19;8:160-169. doi: 10.1016/j.xjtc.2021.04.010. eCollection 2021 Aug.PMID: 34401841 

Esophageal atresia surveillance practices

• Hamilton-Hall MN, Jungbauer D, Finck C, Middlesworth W, Zendejas B, Alaish SM, Griggs CL, Russell RT, Shieh HF, Scholz S, Kunisaki SM, Feng C, Danko ME, DeFazio JR, Smithers CJ, Zamora IJ, Knod JL. Esophageal surveillance practices in esophageal atresia patients: A survey by the Eastern Pediatric Surgery Network study (EPSN). J Pediatr Surg 2023; 58(6): 1213-1218.

Intraoperative recurrent laryngeal nerve monitoring

• Meisner JW, Izadi S, Kamran A, Shieh HF, Smithers CJ, Bennett J, Demehri FR, Mohammed S, Lawlor C, Choi SS*, Zendejas B*. Screening for vocal fold movement impairment in children undergoing esophageal and airway surgery. Laryngoscope 2023; 133(12): 3564-3570.

Anesthesia considerations

• Kuo FH, Elliott RA, Watkins SC, Shieh HF, Smithers CJ, Jennings RW, Munoz-San Julian C. Negative pressure suction test: an intraoperative airway maneuver to assess effectiveness of surgical correction of tracheobronchomalacia. Paediatr Anaesth 2024; 34(4): 289-292.