Office-based tracheoesophageal puncture: Updates in techniques and outcomes

Abstract

Purpose Tracheoesophageal Puncture (TEP) is an effective rehabilitation method for postlaryngectomy speech and has already been described as a procedure that is safely performed in the office. We review our long-term experience with office-based TEP over the past seven years in the largest cohort published to date. Materials and Methods A retrospective chart review was performed of all patients who underwent TEP by a single surgeon from 2005 through 2012, including office-based and operating room procedures. Indications for the chosen technique (office versus operating room) and surgical outcomes were evaluated. Results 59 patients underwent 72 TEP procedures, with 55 performed in the outpatient setting and 17 performed in the operating room, all without complication. The indications for performing TEP’s in the operating room included 2 primary TEP’s, 14 due to concomitant procedures requiring general anesthesia, and 1 due to failed attempt at office-based TEP. 19 patients with prior rotational or free flap reconstruction successfully underwent office-based TEP. Conclusions TEP in an office-based setting with immediate voice prosthesis placement continues to be a safe method of voice rehabilitation for postlaryngectomy patients, including those who have previously undergone free flap or rotational flap reconstruction. Office-based TEP is now our primary approach for postlaryngectomy voice rehabilitation.

Office-based procedures for diagnosis and treatment of esophageal pathology

“…In some cases, direct formation of the fistula is difficult and, thus, needs to be performed in a later stage. Indications are displayed in Table . This procedure is called a secondary TEP and used to be performed by using a rigid endoscope with the patient under general anesthesia .…”

“…Several studies mention good patient tolerability under topical anesthesia and find intelligible speech after voice prosthesis placement . The average duration of in‐office secondary TEP is between 10 and 30 minutes …”

“…Secondary TEP may be indicated in specific laryngectomy patients . Different techniques have been described and no uniform protocols are mentioned.…”

“…In addition, randomized studies that compare direct voice prosthesis placement versus waiting on fistula maturation were not found. Bergeron et al mentioned the advantage of direct prosthesis placement; patients had less outpatient clinic visits to the speech‐language pathologist compared to primary TEP. Damrose et al stated that by delaying voice prosthesis placement after secondary TEP, postprocedural edema could resolve.…”

A Novel Device for Placement of a Secondary Tracheoesophageal Voice Prosthesis: A Preliminary Feasibility Study

“…The flexible esophagoscope can be inserted transorally or transnasally, employs air pressure to atraumatically distend the esophagus, and has a working channel to permit interventions such as balloon dilation and biopsy. The use of flexible esophagoscopy for in-office secondary TEPs has been described, but is not yet common practice [9][10][11]. As office procedures become more prevalent, we believe that our device can ultimately be used in this setting for selected patients.…”