P152 - A CASE OF RECOVERY OF ORAL INTAKE AND PEG REMOVAL AFTER TRACHEOESOPHAGEAL DIVERSION WITH TRACHEOESOPHAGEAL PUNCTURE （TED WITH TEP） SURGERY

P152

A CASE OF RECOVERY OF ORAL INTAKE AND PEG REMOVAL AFTER TRACHEOESOPHAGEAL DIVERSION WITH TRACHEOESOPHAGEAL PUNCTURE （TED WITH TEP） SURGERY

N. Konno^1,*, M. Kagaya², A. Asaoka²

¹otolaryngology-Head and Neck Surgery, ²Nutrition Managements, Sapporo Kojinkai Memorial Hospital, Sapporo, Japan

Rationale: Since 2000, percutaneous endoscopic gastrostomy (PEG) has rapidly gained popularity. Compared to nasogastric tube feeding, PEG offers several advantages, including reduced discomfort, difficulty in removal, and decreased need for restraint, which improves patient agitation.We present a case of severe dysphagia following subarachnoid hemorrhage, managed with tracheostomy and PEG placement. Despite initial challenges in achieving oral intake, TED with TEP surgery enabled complete oral intake and subsequent PEG removal.

Methods:  The patient is a 42-year-old female with a history of subarachnoid hemorrhage surgery (ruptured vertebral artery aneurysm), hydrocephalus surgery, and higher brain dysfunction. Due to dysphagia, she was managed with tracheostomy and PEG for nutrition. To achieve oral intake and tracheal cannula removal, she first visited our department on September , 2020, for evaluation of laryngo-tracheal separation and other laryngeal closure surgeries. She was admitted, and TED with TEP surgery was performed on November , 2020. Postoperative progress was favorable, and swallowing became possible, leading to discharge home on December , 2020.

Results: After discharge, the amount of oral intake gradually increased. Although her weight initially showed an increasing trend, it later decreased and remained almost stable. Two years and five months post-surgery, PEG was no longer used, and nutrition management was completely through oral intake. PEG removal was achieved two years and ten months post-surgery. She continued to live with oral intake only, maintaining her weight.

Conclusion: By performing aspiration prevention surgery that preserves laryngeal voice, we were able to preserve vocal function and enable oral intake. As her activity level increased, complete oral intake was established over the years, making PEG removal possible.

Disclosure of Interest: None declared