The management of periprosthetic leakage in the presence of supra-oesophageal reflux after prosthetic voice rehabilitation

Abstract

The objective of the study was to investigate the influence of anti-reflux medications on the management of periprosthetic leakage in laryngectomised patients with prosthetic voice rehabilitation. Sixty patients underwent laryngectomy and prosthetic voice rehabilitation. In a prospective non-randomised study, we examined the patients clinically and assessed the presence of reflux disease using 24-h dual-probe pH monitoring before and 6 months after oral anti-reflux treatment with proton pump inhibitors (PPIs). The severity of reflux, the effectiveness of anti-reflux therapy, and the clinical success of treatment were evaluated. Reflux parameters before and after anti-reflux therapy as well as the severity and incidence of periprosthetic leakage before and after PPI therapy were the main outcome measures. The absolute number of reflux events was 162.2 (±144.3) before treatment and 63.1 (±87.9) after treatment with PPIs (p = 0.031). The reflex area index score decreased from 327.1 (±419.3) without PPIs to 123.8 (±249.7) with PPIs (p = 0.0228). The mean DeMeester score was 108.3 (±85.4) before treatment and 47.4 (±61.7) after 6 months of treatment (p = 0.0557). The relative risk of periprosthetic leakage decreased to 0.5 after anti-reflux treatment. In 19 patients, leakage problems were successfully managed by rigorous treatment with PPIs. No further surgical procedures were required in these cases. Rigorous anti-reflux treatment leads to an improvement in parameters that can be assessed objectively by 24-h dual-probe pH monitoring. In the majority of patients, the symptoms associated with periprosthetic leakage can be improved or cured.

Postlaryngectomy prosthetic voice rehabilitation outcomes in a consecutive cohort of 232 patients over a 13‐year period

“…In the present cohort with a median follow-up time of over 10 years 7% of the patients were not able to keep their VP, and this figure was 5% with a median follow-up time of over 6 years in our historical cohort. 10,23,24 As these comorbidities are treatable, shortening of the device life might be a reason to start an intervention (dilatation or proton pump inhibitor (PPI) treatment). 22 An interesting aspect of the present study is that we were able to analyze different types of VPs in the same patient over a prolonged period of time.…”

Role of reflux‐induced epithelial–mesenchymal transition in periprosthetic leakage after prosthetic voice rehabilitation

“…Up to now, several potential causes for fistula enlargement have been identified: vascular rarefaction as a consequence of radiotherapy, irritation from micro‐movements of the voice prosthesis, as well as pathological gastroesophageal reflux (GER) . In a previous study, we could demonstrate that in patients presenting with periprosthetic leakage, an increase of pathologic reflux events in the pharyngoesophageal segment is significantly associated with severe enlargement of the speech shunt . Furthermore, we were able to show that rigorous anti‐reflux therapy led to a significant decrease in periprosthetic leakage and fistula enlargement in these patients.…”

“…The procedure of pH monitoring and assessment of reflux has been described in detail in our earlier publication . In short, all patients underwent 24‐hour dual‐probe pH monitoring (Digitrapper, Medtronic Xomed, Jacksonville, FL) after measurement of the initial fistula diameters at the beginning of the study and after 6‐month follow‐up.…”

Gastroesophageal reflux disease and postlaryngectomy tracheoesophageal fistula

“…Moreover, Lorenz [14,15] presents a group of patients with recurrent periprosthetic leakage in the region of the Wstula with a signiWcantly higher number of supraesophageal reXux episodes in whom rigorous anti-reXux treatment helped to manage or prevent problems in a large proportion of patients.…”