The aim of this crossectional study was to investigate the relationship between
pepsin concentration in saliva and the occurrence of
tracheoesophageal fistula (TEF) complications and
voice prosthesis (VP) complications, after total
laryngectomy and VP implantation. We assessed the concentrations of
pepsin in the saliva of 41 laryngectomized patients and correlated it with the incidence of TEF complications (periprostethic leakage,
atrophy, esophageal mucosa
hypertrophy, granulations,
fistula enlargement, and VP dislocation), VP complications (transprosthetic leakage,
Candida infection) and voice quality.
Pepsin levels were measured by
enzyme-linked
immunoadsorbent assay (ELISA). Voice quality was assessed by Harrison-Robilard--Schultz (HRS) scale. In all, 17 (42%) patients had complications. All of them had TEF complications, whereas VP complication, together with TEF was found in 9 (22%) patients. We found no significant correlation between
adjuvant radiotherapy and TEF complications. Most of patients, 30 (73%), had positive
pepsin level in saliva. Median value of
pepsin concentration in all patients was 4.8 (range 81.7). Median
pepsin concentration was higher in patients free of TEF or VP complications (6.6, range 81.7 vs. 3.2, range 19.3) but that difference was not statistically significant (Mann-Whitney test, Z--1.562, p = 0.118). In addition, statistically insignificant negative correlation between
pepsin levels and voice quality measured by HRS scale (Spearman's rho, p > 0.05). Although reflux was proposed as cause of TEF complications and
pepsin has been proven as a most sensitive and specific marker of ekstraesophageal reflux, we did not find any statistically significant correlation between
pepsin levels and occurrence of TEF or VP complications.