Endoscopic Removal of a Displaced Tracheoesophageal Voice Prosthesis
Notice bibliographique
Résumé
CASE REPORT A 66-year-old woman presented with rapidly progressive dysphagia and intolerance to solids and liquids over the course of approximately 10 weeks. Her medical history included laryngeal squamous cell carcinoma treated with total laryngectomy and placement of a tracheoesophageal voice prosthesis 5 years earlier. Neck computed tomography revealed posterior displacement of the tracheoesophageal prosthesis (Figure 1). The external phalange was unable to be visualized externally from the tracheostoma. Transnasal esophagoscopy with otolaryngology confirmed the prosthesis had migrated posteriorly, with the esophageal phalange of the prosthesis partially obstructing within the lumen of the esophagus. Gastroenterology was consulted for endoscopic removal because anterior surgical removal would place the patient at high risk of a large persistent tracheoesophageal fistula, given her history of radiation therapy.Figure 1.: Sagittal computed tomography scan of the neck demonstrating tracheoesophageal prosthesis (white circle) posteriorly displaced with the esophageal phalange resting within the midesophagus.An ultra-slim gastroscope was used because of an area of proximal chronic esophageal stenosis secondary to radiation. Endoscope was advanced into the esophagus to visualize the obstructing phalange of the prosthesis located at approximately 20 cm from the incisors (Figure 2). A snare was advanced through the scope and maneuvered around the phalange of the prosthesis. With constant traction on the snare, the endoscope was slowly withdrawn from the esophagus with successful removal of the prosthesis with no immediate complications (Figure 3).Figure 2.: Esophageal phalange of tracheoesophageal prosthesis causing obstruction of the proximal esophageal lumen as seen on upper endoscopy.Figure 3.: Fully intact tracheoesophageal prosthesis after endoscopic removal with snare, total dimensions 0.5 × 1 cm.The patient's symptoms of dysphagia significantly improved after removal, and she was able to immediately tolerate liquids with advancement to a soft diet over subsequent days. On follow-up lasting 3 months, she continued to have no symptoms of dysphagia with a soft diet and gained a small amount of weight. Given her clinical improvement, she was planned to undergo repeat placement of her voice prosthesis. However, because of her previously identified proximal esophageal stenosis, she was referred for upper endoscopy to reassess and dilate the area of stenosis to facilitate prosthesis placement. Unfortunately, at endoscopy, she was noted to have a narrow and highly fibrotic area of stenosis in the proximal esophagus that appeared to be largely extrinsic, presumed secondary to previous radiation therapy. Dilation with Maloney bougies was attempted, but significant resistance was felt because of the highly fibrotic nature of the stenosis, and the procedure was aborted. As such, otolaryngology did not recommend an attempt at repeat insertion of the tracheoesophageal voice prosthesis at this time, given concerns for poor healing and worsening her dysphagia. DISCLOSURES Author contributions: S. Li wrote the manuscript. S. Li, D. Enepekides, and L. Cohen edited and revised the manuscript for intellectual content. S. Li and L. Cohen provided the images. L. Cohen approved the manuscript and is the article guarantor. Financial disclosures: None to report. Informed consent was obtained for this case report.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».