Analysis of pepsin in tracheoesophageal puncture sites.
OBJECTIVE
Tracheoesophageal puncture (TEP) and prosthesis insertion is a well-established method of voice rehabilitation after laryngectomy. Maintenance of the prosthesis and tract can be challenging, and reflux to the TEP site has been proposed as a cause. The sites of TEP were evaluated for the presence of pepsin in tissue biopsy specimens and tract secretions to explore this association.


METHODS
Patients with TEP were interviewed for a history of symptoms related to reflux, medication use history, TEP voice quality, and incidence of TEP complications. Tissue biopsy specimens and tract secretions were obtained from TEP sites and analyzed for the presence of pepsin via sodium dodecyl sulfate-polyacrylamide gel electrophoresis Western blot analysis.


RESULTS
Twelve of 17 patients (47%) had some history of preoperative or postoperative symptoms of gastroesophageal reflux disease or laryngopharyngeal reflux. Pepsin was present within the TEP site in a total of 10 of 17 patients (58%; 7 of 17 tissue biopsy specimens and 6 of 7 secretion samples). There were no statistically significant associations between the presence of pepsin and sex, reflux history, use of acid suppressive medicine, or time since laryngectomy.


CONCLUSIONS
Reflux with subsequent pepsin deposition into the TEP tract occurs in a majority of laryngectomy patients. Further studies on the effect of reflux on the health and function of the TEP tract are warranted.
Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.
Jonathan M
JM
Bock
Mary K
MK
Brawley
Nikki
N
Johnston
Tina
T
Samuels
Becky L
BL
Massey
Bruce H
BH
Campbell
Robert J
RJ
Toohill
Joel H
JH
Blumin
D000368:Aged; D004947:Esophagus / Q000737:chemistry / Q000601:surgery; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology; D006801:Humans; D007825:Laryngectomy; D057045:Laryngopharyngeal Reflux / Q000209:etiology; D007831:Larynx, Artificial / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010434:Pepsin A / Q000032:analysis*; D019919:Prosthesis Implantation / Q000009:adverse effects; D011677:Punctures; D014132:Trachea / Q000737:chemistry / Q000601:surgery
D010434:Pepsin A