Tracheoesophageal puncture using a flexible gastroscope and a percutaneous endoscopic gastrostomy set

Abstract

Tracheoesophageal puncture is an established procedure for voice restoration following laryngectomy. A method using a flexible gastroscope and a percutaneous endoscopic gastrostomy (PEG) set is described. This overcomes a number of problems and complications which may be encountered when using a rigid endoscope.

In‐Office Tracheoesophageal Puncture Using Transnasal Esophagoscopy

“…More recent reports have described the use of a standard gastroenterological flexible fiberoptic endoscope (passed through the oral cavity) for direct visualization of the esophagus during creation of the TEP. 9–13 This technique offers several advantages, the most important being improved visualization of the operative site within esophageal lumen during TEP. It also averts many of the difficulties and potential complications associated with the use of the rigid endoscope.…”

Secondary tracheoesophageal puncture: Blind technique with a rigid hysterometer

“…Alternative methods of TEP and voice prosthesis housing need to be used in patients with anatomy that does not allow proper passage of large‐caliber rigid instruments. These variations include the use of rigid and flexible endoscopes, a potassium titanyl phosphate laser passed transorally via a suction tube, endotracheal tubes, percutaneous gastrostomy sets, etc 13–21…”

“…Some of these techniques use blind introduction of a hollow instrument, such as a Yankauer tube (Baxter International Inc., Deerfield, IL) or a flexible endotracheal tube, through which a laser fiber or a flexible nasopharyngoscope is introduced to perform or assist the TEP 19, 20. A flexible endoscope may also be introduced directly into the esophagus to transilluminate the posterior tracheal wall, thus helping to define the position of the incision and visualize it on the side of the esophagus 17, 18…”

“…Possible drawbacks are the increased cost, the need for additional surgical instruments, such as a gastrostomy set or esophagoscope, and, unlike with our technique, employment of an assistant alongside the surgeon when using endoscopes 14, 17, 18, 21…”

In-office unsedated tracheoesophageal puncture

“…In addition to the risk of a second general anesthetic, performing rigid esophagoscopy on previously operated and irradiated patients is not without its own morbidity. In recent years there has been a trend towards the use of flexible endoscopes to insufflate the proximal esophagus and improve visualization at the puncture site [7][8][9][10]. The TEP site is then serially dilated using a Seldinger technique before placement of the prosthesis.…”