1
|
Estevinho MM, Pinho R, Rodrigues J, Correia J, Freitas T. Tunneling-free peroral endoscopic septotomy for Zenker diverticulum. VideoGIE 2023; 8:295-297. [PMID: 37575137 PMCID: PMC10422048 DOI: 10.1016/j.vgie.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Video 1Tunneling-free peroral endoscopic Zenker myotomy.
Collapse
Affiliation(s)
- Maria Manuela Estevinho
- Department of Gastroenterology, Vila Nova de Gaia Espinho Hospital Center, Vila Nova de Gaia, Portugal
| | - Rolando Pinho
- Department of Gastroenterology, Vila Nova de Gaia Espinho Hospital Center, Vila Nova de Gaia, Portugal
| | - Jaime Rodrigues
- Department of Gastroenterology, Vila Nova de Gaia Espinho Hospital Center, Vila Nova de Gaia, Portugal
| | - João Correia
- Department of Gastroenterology, Vila Nova de Gaia Espinho Hospital Center, Vila Nova de Gaia, Portugal
| | - Teresa Freitas
- Department of Gastroenterology, Vila Nova de Gaia Espinho Hospital Center, Vila Nova de Gaia, Portugal
| |
Collapse
|
2
|
Hoyos-Rincón M, Fuentes-Díaz CF, Jesús Antonio JA. Z-POEM: ¿Procedimiento ideal para el tratamiento del divertículo de Zenker? Rev Colomb Cir 2023. [DOI: 10.30944/20117582.2284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Introducción. El divertículo de Zenker es una patología poco frecuente, caracterizada por la presencia de disfagia, halitosis, tos y pérdida de peso, que afectan la calidad de vida de los pacientes. El tratamiento es quirúrgico y las técnicas han evolucionado de forma permanente. El objetivo de este estudio fue evaluar la mejoría de la disfagia en pacientes a quienes se les realizó la técnica de miotomía endoscópica peroral (Z-POEM).
Métodos. Estudio descriptivo de una serie de 23 pacientes con divertículo de Zenker diagnosticado por endoscopia y esofagograma, tratados entre mayo de 2018 y noviembre de 2021 en diferentes instituciones de la ciudad de Bogotá, D.C., Colombia, mediante una miotomía endoscópica del cricofaríngeo con la técnica de Z-POEM.
Resultados. La mayoría de los pacientes fueron adultos mayores, de sexo masculino. Los síntomas más frecuentes correspondieron a disfagia y regurgitación. El tamaño promedio del divertículo fue de tres centímetros. La estancia hospitalaria fue de un día. Un paciente presentó disfagia postoperatoria en relación con los clips y otro presentó un absceso mediastinal, el cual fue resuelto de manera endoscópica. Actualmente, todos los pacientes se encuentran asintomáticos y no han presentado recurrencia.
Conclusiones. El tratamiento endoscópico mínimamente invasivo mediante la miotomía endoscópica peroral (Z-POEM) en el paciente con divertículo de Zenker es una alternativa segura y eficaz, con buenos resultados y poca morbilidad.
Collapse
|
3
|
Parsa N, Friedel D, Stavropoulos SN. POEM, GPOEM, and ZPOEM. Dig Dis Sci 2022; 67:1500-1520. [PMID: 35366120 DOI: 10.1007/s10620-022-07398-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 12/09/2022]
Abstract
Our tripartite narrative review discusses Peroral Endoscopic Myotomy (POEM), gastric POEM (GPOEM) and POEM for Zenker's diverticula (ZPOEM). POEM is the prototypical procedure that launched the novel "3rd space endoscopy" field of advanced endoscopy. It revolutionized achalasia therapy by offering a much less invasive version of the prior gold standard, the laparoscopic Heller myotomy (HM). We review in detail indications, outcomes, technique variations and comparative data between POEM and HM particularly with regard to the hotly debated issue of GERD. We then proceed to discuss two less illustrious but nevertheless important offshoots of the iconic POEM procedure: GPOEM for gastroparesis and ZPOEM for the treatment of hypopharyngeal diverticula. For GPOEM, we discuss the rationale of pylorus-directed therapies, briefly touch on GPOEM technique variations and then focus on the importance of proper patient selection and emerging data in this area. On the third and final part of our review, we discuss ZPOEM and expound on technique variations including our "ultra-short tunnel technique". Our review emphasizes that, despite the superiority of endoscopy over surgery for the treatment of hypopharyngeal diverticula, there is no clear evidence yet of the superiority of the newfangled ZPOEM technique compared to the conventional endoscopic myotomy technique practiced for over two decades prior to the advent of ZPOEM.
Collapse
Affiliation(s)
- Nasim Parsa
- Division of Gastroenterology and Hepatology, University of Missouri Health System, Columbia, MO, USA
| | - David Friedel
- Division of Gastroenterology, Hepatology and Nutrition, NYU-Winthrop Hospital, 222 Station Plaza N Suite 429, Mineola, NY, 11501, USA
| | - Stavros N Stavropoulos
- Division of Gastroenterology, Hepatology and Nutrition, NYU-Winthrop Hospital, 222 Station Plaza N Suite 429, Mineola, NY, 11501, USA.
| |
Collapse
|
4
|
Budnicka A, Januszewicz W, Białek AB, Spychalski M, Reguła J, Kaminski MF. Peroral Endoscopic Myotomy in the Management of Zenker's Diverticulum: A Retrospective Multicenter Study. J Clin Med 2021; 10:jcm10020187. [PMID: 33430367 PMCID: PMC7826711 DOI: 10.3390/jcm10020187] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/28/2020] [Accepted: 12/30/2020] [Indexed: 12/01/2022] Open
Abstract
Background: Peroral endoscopic myotomy (POEM) is an emerging technique in the treatment of Zenker’s diverticulum (ZD). This study aimed to analyze the feasibility of Zenker’s POEM (Z-POEM) in a multicenter setting and assess its performance using a validated Kothari-Haber Scoring System newly developed for symptom measurement in ZD. Materials and methods: This was a multicenter retrospective study involving three Polish tertiary referral endoscopic units. The data of consecutive patients with symptomatic ZD treated with Z-POEM in Poland between May 2019 and August 2020 were retrieved and analyzed. Primary outcome measures were technical success and clinical success rate (<3 points in Kothari-Haber Score at 2–3 months follow-up). Secondary outcome measures included procedures’ duration, length of hospital stay, and adverse events. Results: 22 patients with symptomatic ZD were included. The mean age was 67.6 (±10.7) years, and 14 (63.6%) were male. All but two patients were treatment naïve. The average size of the ZD was 30 mm (IQR, 24–40 mm). Technical success was achieved in all patients (100%), whereas clinical success was 90.9%. The average Kothari-Haber Score was 6.35 before treatment and has dropped to 0.65 after the treatment (p < 0.0001). The mean procedure time was 48.8 (±19.3) minutes, and the median length of hospital stay was 2 days (IQR, 2–3). Three patients (13.6%) had post-procedural emphysema, of which two were mild and self-resolving (9.1%), and one was moderate (4.5%) and complicated with laryngeal edema and prolonged intubation. Conclusions: This feasibility study suggests that Z-POEM is a highly effective and safe treatment for ZD, particularly among treatment-naïve patients. Comparative studies with other treatment modalities over longer follow-up are warranted.
Collapse
Affiliation(s)
- Aleksandra Budnicka
- Department of Gastroenterological Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (A.B.); (W.J.); (J.R.)
- Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, 02-781 Warsaw, Poland
| | - Władysław Januszewicz
- Department of Gastroenterological Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (A.B.); (W.J.); (J.R.)
- Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, 02-781 Warsaw, Poland
| | - Andrzej B. Białek
- Department of Gastroenterology, Pomeranian Medical University, 70-204 Szczecin, Poland;
| | - Michal Spychalski
- Center of Bowel Treatment, University of Lodz, 95-060 Brzeziny, Poland;
| | - Jaroslaw Reguła
- Department of Gastroenterological Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (A.B.); (W.J.); (J.R.)
- Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, 02-781 Warsaw, Poland
| | - Michal F. Kaminski
- Department of Gastroenterological Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (A.B.); (W.J.); (J.R.)
- Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, 02-781 Warsaw, Poland
- Institute of Health and Society, University of Oslo, 1130 Oslo, Norway
- Correspondence:
| |
Collapse
|
5
|
Calavas L, Brenet E, Rivory J, Guillaud O, Saurin JC, Ceruse P, Ponchon T, Pioche M. Zenker diverticulum treatment: retrospective comparison of flexible endoscopic window technique and surgical approaches. Surg Endosc 2020; 35:3744-3752. [PMID: 32780234 DOI: 10.1007/s00464-020-07865-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 08/05/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Different treatments exist for Zenker diverticulum. We compared flexible endoscopic myotomy of the cricopharyngeal muscle, using a technique called the "window technique" in order to improve the field of view, to surgical approaches. MATERIALS AND METHODS Patients were retrospectively included and divided into a gastrointestinal group, with flexible endoscopic myotomy, and an ear-nose-throat treatments group with either rigid endoscopic treatment, either cervicotomy. We evaluated effectiveness in terms of quality of life (on a scale on 0 to 10) safety and technical aspects of each procedure. RESULTS A total 106 patients who underwent 128 interventions were included. Rigid endoscopic procedures were the shortest (p < 0.001), with no difference for adverse event. Endoscopic approaches, flexible and rigid ones, were associated with shorter time to intake resumption (1 and 3 days, respectively, vs 6 after cervicotomy) and shorter length of hospital stay (3 and 4 days, respectively, vs 7 after cervicotomy) (p = 0.001). Post-operative QoL was better after flexible endoscopy (9/10) and open cervicotomy (9/10) than after rigid endoscopy (7/10) (p = 0.004). Patients declared fewer residual symptoms after open cervicotomy (77% of low symptomatic patients) and flexible endoscopy (80%) than after rigid endoscopy (43%) (p = 0.003). Conversion to open surgery was more frequent during rigid than flexible endoscopies (18% vs 0%, p = 0.0008). CONCLUSION Flexible endoscopic approach of Zenker diverticulum treatment seems to be safe and effective and may be an alternative to surgical approaches. Myotomy can be eventually helped by the window technique.
Collapse
Affiliation(s)
- Laura Calavas
- Gastroenterology and Endoscopy Unit, Hospices Civils de Lyon, Hôpital E.Herriot, Lyon, France.,Inserm U1032, Labtau, Lyon, France
| | - Esteban Brenet
- Head and Neck Surgery Departments, Hospices Civils de Lyon, Hôpital de La Croix-Rousse and Hôpital Lyon Sud, Lyon, France.,Inserm U1032, Labtau, Lyon, France
| | - Jérôme Rivory
- Gastroenterology and Endoscopy Unit, Hospices Civils de Lyon, Hôpital E.Herriot, Lyon, France.,Inserm U1032, Labtau, Lyon, France
| | - Olivier Guillaud
- Gastroenterology and Endoscopy Unit, Hospices Civils de Lyon, Hôpital E.Herriot, Lyon, France.,Inserm U1032, Labtau, Lyon, France
| | - Jean-Christophe Saurin
- Gastroenterology and Endoscopy Unit, Hospices Civils de Lyon, Hôpital E.Herriot, Lyon, France.,Inserm U1032, Labtau, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France.,Service de Gastro-entérologie Et D'endoscopie Digestive, Pavillon L - Hôpital Edouard Herriot, 69437, Lyon, France
| | - Philippe Ceruse
- Head and Neck Surgery Departments, Hospices Civils de Lyon, Hôpital de La Croix-Rousse and Hôpital Lyon Sud, Lyon, France.,Inserm U1032, Labtau, Lyon, France.,Service de Gastro-entérologie Et D'endoscopie Digestive, Pavillon L - Hôpital Edouard Herriot, 69437, Lyon, France
| | - Thierry Ponchon
- Gastroenterology and Endoscopy Unit, Hospices Civils de Lyon, Hôpital E.Herriot, Lyon, France.,Inserm U1032, Labtau, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France.,Service de Gastro-entérologie Et D'endoscopie Digestive, Pavillon L - Hôpital Edouard Herriot, 69437, Lyon, France
| | - Mathieu Pioche
- Gastroenterology and Endoscopy Unit, Hospices Civils de Lyon, Hôpital E.Herriot, Lyon, France. .,Inserm U1032, Labtau, Lyon, France. .,Université Claude Bernard Lyon 1, Lyon, France. .,Service de Gastro-entérologie Et D'endoscopie Digestive, Pavillon L - Hôpital Edouard Herriot, 69437, Lyon, France.
| |
Collapse
|