In-Office Transnasal Tracheoesophageal Punctures Yield Good Results

Secondary tracheoesophageal puncture (TEP) performed in the office on total-laryngectomy patients, using transnasal esophagoscopy, yielded good results, researchers have reported.

Nearly all of the 39 procedures reviewed in the retrospective study were successful, and speech results were also good, said Brad LeBert, MD, of the Department of Otolaryngology-Head and Neck Surgery at the Louisiana State Health Sciences Center in Shreveport, in a presentation at the 2009 annual meeting of the American Head and Neck Society, held as part of the Combined Otolaryngology Spring Meeting.

The patient was able to avoid the risk of general anesthesia, and this also offered a decreased cost of the procedure, not only to the patient, but also to the hospital, Dr. LeBert said.

In-office tracheoesophageal prosthesis placement with the use of transnasal esophagoscopy [TNE] is a very viable procedure to be done by any otolaryngologist familiar with TNE techniques, said Amy Hessel, MD, Assistant Professor of Head and Neck Surgery at the University of Texas M. D. Anderson Cancer Center (MDACC) in Houston, and one of the surgeons who performed the procedures. This procedure utilizes principles and procedures that all otolaryngologists are familiar with-endoscopy and Seldinger technique.

She cautioned that there are key points that must not be forgotten. While this procedure is technically easy and provides an excellent service for those patients rendered aphonic from laryngectomy, there are a few aspects that must not be overlooked, she said. It is absolutely imperative that these patients be supported by a speech pathology group who are familiar with TEP and are able to assist with initial candidate assessment, TEP placement, vocal instruction, and maintenance of the prosethesis.

Background on TEP

Tracheoesophageal puncture, introduced in 1980, can be done either at the time of the total laryngectomy, as a primary procedure, or later as in a secondary procedure. Using TNE for the procedure was introduced in 2003 by Bach, Postma, and Koufman (Laryngoscope 2003;113: 173-6).

The procedure used in the study presented by Dr. LeBert, performed at LSU Health Sciences Center and M. D. Anderson Cancer Center, involves keeping the patient awake without any sedation, using only local anesthesia. TNE is used for endoscopic guidance. The puncture is made either using a direct puncture method or the Seldinger technique, in which a hollow needle is used to make the puncture, allowing a guidewire to be passed through.

There are several scopes available for transnasal esophagoscopy. The one used in this study was the Olympus model. They all have varying benefits associated with them, Dr. LeBert said. They all share the common factor that they have a very small diameter of about 5 millimeters. This allows for easy passage through the nose and into the nasopharynx. A traditional esophagascope has an average diameter of 13 mm.

TEP Study

The retrospective review covered 39 patients receiving the treatment from January of 2004 to December of 2008. Their average age was 65, ranging from 47 to 83. Eighty-two percent were male.