Endoscopic visualization for tracheoesophageal puncture tract sizing

Abstract

Background

Accurate tracheoesophageal prosthesis (TEP) size is essential for optimal functioning. Current sizing techniques do not afford direct visualization. The clinical utility of direct visualization with unsedated transnasal esophagoscopy (TNE) to improve TEP sizing accuracy has not been established.

Aims/Objectives

The purpose of this investigation was to determine if endoscopic visualization with TNE during TEP fitting improves sizing accuracy.

Material and Methods

Participants undergoing secondary TEP placement had their TEP sized without visualization and with visualization during TNE. The effect of endoscopic visualization on TEP sizing was assessed.

Results

The mean age (SD) of the cohort (N = 15) was 61.20 (±10.19) years. The percent disagreement between non-visualized and endoscopic-visualized puncture tract measurement was 60%. The mean difference in puncture tract length with visualization compared to without visualization was 1.75 mm (±1.91). Discordance between non-visualized and endoscopic-visualized puncture tract length was worse for persons with a history of radiation (66.7%) than without radiation (33.3%) (p < .05). The overall test agreement between endoscopic and non-endoscopic sizing techniques was moderate (Cohen’s kappa coefficient = 0.254; (p < .05).

Conclusion and Significance

The percent disagreement between non-visualized and endoscopic-visualized TEP sizing is high (60%). The data suggest that endoscopic visualization with TNE improves sizing accuracy during TEP placement.

Chinese abstract

背景：气管食管假体（TEP）的准确尺寸对于取得最佳功能至关重要。当前的尺寸调整技术无法提供直接的可视性。对未施镇静措施的经鼻食管镜检查（TNE）来提高TEP的尺寸精度的直接可视性的临床用途尚未确立。

目的：本研究的目的是, 确定TEP放置过程中通过TNE内窥镜可视化是否可以提高尺寸精度。

材料和方法：接受二次TEP放置的参与者的TEP尺寸在TNE期间经无可视化和可视化来确定。评估内窥镜可视化对TEP尺寸的影响。

结果：该研究对象群体（N¼15）的平均年龄为61.20（±10.19）岁。非可视化和内窥镜可视化穿刺测量之间的不一致性百分比为60％。可视化与非可视化穿刺长度的均值差异为1.75毫米（±1.91）。与没有放射史的人（33.3％）相比, 有放射史的人（66.7％）的非可视和内窥镜可视穿刺长度之间的差异更糟（p <.05）。内窥镜和非内窥镜尺寸技术之间的总体测试一致性还可以（Cohen卡伯系数¼0.254; p <.05）。

结论和意义：非可视化和内窥镜可视化TEP尺寸之间的不一致性百分比很高（60％）。数据表明, TNE的内窥镜可视化可以改善TEP放置过程中的尺寸精度。

Keywords:

• Laryngectomy
• tracheoesophageal voice prosthesis
• alaryngeal speech
• diagnostic

Disclosure statement

No potential conflict of interest was reported by the author(s).

Level of evidence

2b – individual retrospective cohort study