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CC BY 4.0 · Endoscopy 2024; 56(S 01): E156-E157
DOI: 10.1055/a-2254-7503
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Endoscopic submucosal dissection for esophageal cancer behind a tracheoesophageal voice prosthesis

Yasuhiro Tani 
1   Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Koji Higashino
1   Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Takashi Kanesaka 
1   Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
2   Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
,
Kengo Aoki
3   Department of Head and Neck Surgery, Osaka International Cancer Institute, Osaka, Japan
,
Takashi Fujii
3   Department of Head and Neck Surgery, Osaka International Cancer Institute, Osaka, Japan
,
Tomoki Michida
1   Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
,
Ryu Ishihara
1   Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
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A tracheoesophageal voice prosthesis is used to restore vocal communication after a total laryngectomy [1] [2]. This device may interfere with the endoscope during endoscopic treatment of an esophageal lesion. However, its removal poses a risk of aspiration because it is located in a tracheoesophageal fistula. We successfully performed endoscopic submucosal dissection (ESD) for superficial esophageal squamous cell carcinoma behind a tracheoesophageal voice prosthesis.

A 65-year-old man was diagnosed, by means of upper gastrointestinal endoscopy, as having a superficial lesion on his upper thoracic esophagus. The oral part of the lesion was behind a tracheoesophageal voice prosthesis, which was placed after total laryngectomy and jejunal interposition for hypopharyngeal cancer. ESD was planned to be performed under general anesthesia to reduce the risk of aspiration when the tracheoesophageal voice prosthesis was removed.

The patient underwent tracheal intubation, and the intubation balloon was placed caudally to the lesion to prevent aspiration ([Fig. 1]). After the voice prosthesis was removed, the endoscope was inserted, and markings were made around the lesion ([Video 1]). ESD was performed using a FlushKnife BT-S (1.5 mm, DK2620J; Fujifilm Medical, Tokyo, Japan) and the lesion was resected en bloc. After replacement of the voice prosthesis, extubation was performed. Histopathological examination revealed squamous cell carcinoma confined to the epithelium. As the lesion was completely removed endoscopically, the patient was followed up without additional treatment. After 8 months, no local recurrence was detected on surveillance endoscopy.

Zoom Image
Fig. 1 Schematic diagrams. a The oral part of the superficial esophageal lesion behind a voice prosthesis. b The intubation balloon was placed caudally to the lesion and the voice prosthesis was removed.
Endoscopic submucosal dissection for a superficial esophageal lesion, the oral side of which was behind a tracheoesophageal voice prosthesis.Video 1

ESD was successfully performed without any adverse events under general anesthesia by adjusting the cuff position of the intubation tube.

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Conflict of Interest

T. Kanesaka has received honoraria from Olympus, AstraZeneca, and AI Medical Service. R. Ishihara has received honoraria from Olympus, FUJIFILM Medical, Daiichi-Sankyo, Miyarisan Pharmaceutical, AI Medical Service, Astra Zeneca, MSD, and Ono Pharmaceutical. Y. Tani, K. Higashino, K. Aoki, T. Fujii, and T. Michida declare that they have no conflict of interest.

Acknowledgement

We would like to thank Editage (www.editage.jp) for English language editing.

  • References

  • 1 Terada T, Saeki N, Toh K. et al. Voice rehabilitation with Provox2 voice prosthesis following total laryngectomy for laryngeal and hypopharyngeal carcinoma. Auris Nasus Larynx 2007; 34: 65-71
    CrossrefPubMedSearch in Google Scholar
  • 2 Apert V, Carsuzaa F, Tonnerre D. et al. Speech restoration with tracheoesophageal prosthesis after total laryngectomy: an observational study of vocal results, complications and quality of life. Eur Ann Otorhinolaryngol Head Neck Dis 2022; 139: 73-76
    CrossrefPubMedSearch in Google Scholar

Correspondence

Takashi Kanesaka, MD
Department of Gastrointestinal Oncology, Osaka International Cancer Institute
3-1-69 Otemae, Chuo-ku, Osaka 541-8567
Japan   

Publication History

Article published online:
15 February 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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  • References

  • 1 Terada T, Saeki N, Toh K. et al. Voice rehabilitation with Provox2 voice prosthesis following total laryngectomy for laryngeal and hypopharyngeal carcinoma. Auris Nasus Larynx 2007; 34: 65-71
    CrossrefPubMedSearch in Google Scholar
  • 2 Apert V, Carsuzaa F, Tonnerre D. et al. Speech restoration with tracheoesophageal prosthesis after total laryngectomy: an observational study of vocal results, complications and quality of life. Eur Ann Otorhinolaryngol Head Neck Dis 2022; 139: 73-76
    CrossrefPubMedSearch in Google Scholar

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Zoom Image
Fig. 1 Schematic diagrams. a The oral part of the superficial esophageal lesion behind a voice prosthesis. b The intubation balloon was placed caudally to the lesion and the voice prosthesis was removed.