Complications of Secondary Tracheoesophageal Puncture: The Cleveland Clinic Foundation Experience

Abstract

One hundred forty-six secondary tracheoesophageal puncture (TEP) procedures were performed on 132 patients at the Cleveland Clinic Foundation in the past 10 years. The complications of these procedures are reviewed, along with assessment of potential risk factors such as irradiation, esophageal/hypopharyngeal stricture, alcoholism, diabetes, or chronic obstructive pulmonary disease. Among the subgroups studied, only stricture dilation was associated with an increased incidence of postsurgical complications. The majority of these, however, were immediate, and were probably related to the esophagoscopy or dilation itself. The incidence of TEP-related complications in all groups of patients may be higher than previously suspected.

Surgical complications of tracheo-oesophageal puncture and speech valves

“…Otolaryngologists traditionally expect problems related to scar formation and vascular impairment to follow external beam radiotherapy but many retrospective studies fail to demonstrate any adverse effect on SVR [23][24][25][26][27]. By contrast, Silverman and Black [28], while reporting no difference in rates of TOF migration, extrusion or fistula, identified a better functional outcome at 3 months in patients who had not undergone radiotherapy.…”

“…Mehle et al [26] described trauma to the lips, teeth and mucosal lacerations in 7% of secondary TOPs. Bleeding from a mucosal laceration during the procedure or puncture through the vasculature of a previous flap, requiring blood transfusion, are recognized [26].…”

“…Mehle et al [26] described trauma to the lips, teeth and mucosal lacerations in 7% of secondary TOPs. Bleeding from a mucosal laceration during the procedure or puncture through the vasculature of a previous flap, requiring blood transfusion, are recognized [26]. Oesophagoscopy for secondary puncture may be technically difficult owing to a tortuous neopharynx, stenosis or stricture formation [26] and cervical spine deformity, especially after radiotherapy [21,24].…”

“…Several cases of oesophageal perforation resulting in mediastinitis shortly after have been reported [23,26]: these cases were associated with stricture in the neopharynx. Silver et al [29] reported fracture of the cervical vertebrae during oesophagoscopy and TOP.…”

“…One consequence was a delayed mediastinal abscess [45]. Septicaemia [34], delayed pneumomediastinum [46], cervical cellulitis [37] and sternoclavicular septic arthritis [26] have also been described. TOP patients should also be monitored for pneumothorax, pneumomediastinum [46] and subcutaneous emphysema [42].…”