Replacement of a failed tracheoesophageal puncture prosthesis under direct vision. (Esophagoscopy Clinic).

We evaluated a 63-year-old man who had earlier undergone a total laryngectomy for the treatment of T3N0M0 squamous cell carcinoma of the larynx. He had come to our center with a chief complaint of a failed tracheoesophageal puncture (TEP) prosthesis. He had earlier undergone two unsuccessful attempts by a speech language pathologist to replace the prosthesis.

Transnasal esophagoscopy (TNE) identified the poorly placed prosthesis buried within some edematous esophageal mucosa (figure, A). The prosthesis was removed and the gelcap of a new in-dwelling catheter was placed under direct vision (figure, B). Examination after the gelcap had dissolved revealed that the inner flange of the in-dwelling TEP prosthesis was in excellent position (figure, C).