Background
We describe a novel technique using an endotracheal tube to perform tracheo-oesophageal puncture in difficult patients.
Technique
The endotracheal tube is sized according to the patient’s oesophageal diameter. A 10mm window is cut in the anterior wall in the distal fifth of the endotracheal tube (Fig 1). The oesophagus is then cannulated with the endotracheal tube so that the prefashioned window lies against the posterior wall of the tracheal stoma at the site for the tracheo-oesophageal fistula, aided by inserting a fibreoptic nasendoscope. The Blom-Singer® valve (Forth Medical, Newbury, UK) is then inserted at the site for the puncture as guided by the light from the fibreoptic nasendoscope (Fig 2). In cases where this is technically difficult, a 12G Jacques catheter can be passed through the puncture site and through the oral cavity, and fixed to the other end, allowing maturation of the fistula.
Figure 1.
Prefashioned window on anterior endotracheal tube wall
Figure 2.
Use of the fibreoptic nasendoscope as a guide light for the puncture site
Discussion
Secondary tracheo-oesophageal puncture following laryngectomy, as described by Singer and Blom, has a proven track record in providing voice rehabilitation.1–3 This technique has since been modified; the use of an endotracheal tube has been described previously by Maniglia and Cannon.4,5 The advantages of this technique are that it is useful in technically difficult patients, it allows direct visualisation of the oesophageal lumen during puncture and stenting of the distal oesophagus is possible. The equipment is readily available, and compared with a gastroscope, the flexible nasendoscope has a narrower diameter and is therefore easier to pass in a narrow oesophagus.
References
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