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Endoscopic visualization for tracheoesophageal puncture tract sizing.

Lisa M Evangelista1, Tess Andrews1, Ahmed Bayoumi1

  • 1Center for Voice and Swallowing, Department of Otolaryngology - Head and Neck Surgery, University of California Davis, Sacramento, CA, USA.

Acta Oto-Laryngologica
|April 7, 2021
PubMed
Summary

Endoscopic visualization using transnasal esophagoscopy (TNE) during tracheoesophageal prosthesis (TEP) fitting shows improved sizing accuracy. This method reduces the significant 60% disagreement seen with non-visualized sizing techniques.

Keywords:
Laryngectomyalaryngeal speechdiagnostictracheoesophageal voice prosthesis

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Area of Science:

  • Otolaryngology
  • Speech-Language Pathology
  • Medical Device Technology

Background:

  • Accurate tracheoesophageal prosthesis (TEP) sizing is critical for optimal function after laryngectomy.
  • Current TEP sizing methods lack direct visualization, potentially leading to inaccuracies.
  • The clinical benefit of using transnasal esophagoscopy (TNE) for direct visualization during TEP sizing is not well-established.

Purpose of the Study:

  • To evaluate whether direct endoscopic visualization with TNE during TEP fitting enhances sizing accuracy.
  • To compare TEP sizing results obtained with and without endoscopic guidance.

Main Methods:

  • A cohort of 15 participants undergoing secondary TEP placement was studied.
  • Tracheoesophageal prostheses were sized both without direct visualization and with visualization during unsedated TNE.
  • The impact of endoscopic visualization on the accuracy of TEP sizing was assessed.

Main Results:

  • A 60% disagreement was observed between non-visualized and endoscopic-visualized TEP sizing.
  • The mean difference in puncture tract length was 1.75 mm (±1.91) when using visualization.
  • Sizing discordance was significantly higher in patients with a history of radiation (66.7%) compared to those without (33.3%).
  • Overall agreement between the two sizing techniques was moderate (Cohen's kappa = 0.254).

Conclusions:

  • A high percentage of disagreement (60%) exists between non-visualized and visualized TEP sizing methods.
  • Endoscopic visualization with TNE appears to improve the accuracy of TEP sizing during placement.
  • These findings support the integration of TNE for enhanced TEP fitting accuracy.