S4365 TEP: A Rare Cause of Dysphagia

Introduction: A tracheoesophageal puncture (TEP) device is placed by Otolaryngologist after complete laryngectomy procedures to help improve patients communication without a voice box. Dysphagia is often a described complication even though no confirmed incidence or prevalence rates are found in literature. Here we present an unusual case of dysphasia by TEP device. Case Description/Methods: A 53-year-old man with past medical history significant for tobacco use complicated by chronic obstructive pulmonary disease and T4N0 laryngeal carcinoma status post chemotherapy, radiation, and complete laryngectomy who presents to the gastroenterology clinic for worsening dysphagia for the last 3 months. Dysphagia is to solid food only without nausea or vomiting. Patient is maintaining weight with supplemental nutrition through percutaneous endoscopic tube. In the clinic, patient had normal vitals. Physical exam revealing a thin man. Laryngectomy tube and PEG tube were in place without leakage or skin breakdown. Esophagogastroduodenoscopy showed a proximal-to-mid esophageal stenosis at tracheoesophageal puncture device site. Endoscope was able to pass device with some resistance. No food bolus or impactions noted. He was referred to ENT for further evaluation and recommendations. Discussion: This case highlights an unusual and rare cause of dysphagia from iatrogenic trachea-esophageal puncture to allow for voice prosthesis communication after complete laryngectomy. Per multiple case reports, dysphagia is a common complication after laryngeal cancer along with radiation induced fibrosis, post-operation strictures/adhesions, and iatrogenic stricture from TEP. Treatment is usually managed in the ENT office by repositioning TEP at different site in esophagus versus placing a different TEP with thinner hood.