Alessandro Repici1,2, Marco Spadaccini1,2, Paul James Belletrutti2, Piera Alessia Galtieri1, Alessandro Fugazza1, Andrea Anderloni1, Silvia Carrara1, Milena Di Leo2, Gaia Pellegatta1, Annalisa Cappello1, Carlo Castoro2, Yervant Ichkhanian3, Mouen A Khashab3, Roberta Maselli1.
Abstract
BACKGROUND: Treatments of Zenker's diverticulum aim to dissect the cricopharyngeal muscle, removing the underlying source of dysfunction. This is difficult in patients with a short-septum (≤ 20 mm) diverticulum because the limited anatomical space restricts the operating area for either rigid or flexible endoscopic approaches. The aim of this study was to investigate the efficacy and safety of a novel third-space approach, peroral endoscopic septotomy (POES), for treating symptomatic patients with short-septum Zenker's diverticulum.
METHODS: All patients with short-septum Zenker's diverticulum who were referred for endoscopic repair from September 2017, were considered for the study. Outcomes included procedure-related adverse events and symptom improvement. The Dakkak - Bennett score was used to quantify dysphagia.
RESULTS: 20 patients (men 12, women 8; mean age 67.9 years [SD 14.3]) underwent POES. All procedures were performed with patients under deep sedation. Mean size of Zenker's diverticulum was 17.5 mm (SD 3.0) and mean dysphagia score was 2.7 (SD 0.5). Average procedure time was 13.8 minutes (SD 5.1). No intra- or post- procedural adverse events occurred. Septal myotomy was successfully completed in all patients. Dysphagia significantly improved in 19 out of 20 patients. Dakkak - Bennett score improved to 0.3 (SD 0.5), P < 0.0001). No recurrences were reported in a mean follow-up time of 12.0 months (SD 3.7, range 6 - 20).
CONCLUSIONS: POES may be considered as a potential alternative for the treatment of short-septum Zenker's diverticulum. Further data are required to validate this technique and compare it with already available rigid and flexible approaches. © Georg Thieme Verlag KG Stuttgart · New York.
BACKGROUND: Treatments of Zenker's diverticulum aim to dissect the cricopharyngeal muscle, removing the underlying source of dysfunction. This is difficult in patients with a short-septum (≤ 20 mm) diverticulum because the limited anatomical space restricts the operating area for either rigid or flexible endoscopic approaches. The aim of this study was to investigate the efficacy and safety of a novel third-space approach, peroral endoscopic septotomy (POES), for treating symptomatic patients with short-septum Zenker's diverticulum.
METHODS: All patients with short-septum Zenker's diverticulum who were referred for endoscopic repair from September 2017, were considered for the study. Outcomes included procedure-related adverse events and symptom improvement. The Dakkak - Bennett score was used to quantify dysphagia.
RESULTS: 20 patients (men 12, women 8; mean age 67.9 years [SD 14.3]) underwent POES. All procedures were performed with patients under deep sedation. Mean size of Zenker's diverticulum was 17.5 mm (SD 3.0) and mean dysphagia score was 2.7 (SD 0.5). Average procedure time was 13.8 minutes (SD 5.1). No intra- or post- procedural adverse events occurred. Septal myotomy was successfully completed in all patients. Dysphagia significantly improved in 19 out of 20 patients. Dakkak - Bennett score improved to 0.3 (SD 0.5), P < 0.0001). No recurrences were reported in a mean follow-up time of 12.0 months (SD 3.7, range 6 - 20).
CONCLUSIONS: POES may be considered as a potential alternative for the treatment of short-septum Zenker's diverticulum. Further data are required to validate this technique and compare it with already available rigid and flexible approaches. © Georg Thieme Verlag KG Stuttgart · New York.
Entities:
Mesh：
Year: 2020
PMID： 32185781 DOI： 10.1055/a-1127-3304
Source DB: PubMed Journal: Endoscopy ISSN： 0013-726X Impact factor: 10.093