Endoscopic Removal of a Displaced Tracheoesophageal Voice Prosthesis
Bibliographic record
Abstract
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 With constant traction on the snare, the endoscope was slowly withdrawn from the esophagus with successful removal of the prosthesis with no immediate complications (Figure 3).Figure 2.: Esophageal phalange of tracheoesophageal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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.006 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".