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Fistulization between the respiratory and gastrointestinal tracts is an uncommon problem that results from a spectrum of disease processes. Tracheoesophageal fistula (TEF) formation can be either acquired or congenital; the congenital variety is a rare problem of early infancy and will not be discussed in this review article. Acquired TEFs usually result from malignancy, with the primary tumor location being the esophagus, but many nonmalignant entities can also result in TEF formation. The timely diagnosis of TEF is of vital importance to avoid serious complications such as malnutrition, chronic pulmonary infection, and ultimately overwhelming sepsis and death. In this article, we review the approach to TEFs in regards to etiology, fistula anatomy, diagnosis, and management. We place particular emphasis on a multimodality approach to this complex entity while highlighting important recent medical and surgical developments.