Zenker's peroral endoscopic myotomy for management of large Zenker's diverticulum.
| Autor: | Zhang LY; Johns Hopkins Medicine, Baltimore, Maryland, United States., Hernández Mondragón O; National Medical Center Century XXI, Mexico City, Mexico., Pioche M; Hospital Edouard Herriot, Lyon, Rhone-Alpes, France., Steinway SN; Johns Hopkins Medicine, Baltimore, Maryland, United States., Nieto J; Borland Groover, Jacksonville, Florida, United States., Ujiki MB; NorthShore University Health System, Evanston, Illinois, United States., VanDruff VN; NorthShore University Health System, Evanston, Illinois, United States., Kim RE; Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland, United States., Canakis A; Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland, United States., Tantau M; 'Prof Dr Octavian Fodor' Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Cluj, Romania., Tantau A; Gastroenterology and Hepatology Medical Center, Cluj-Napoca, Cluj, Romania., Pop A; Gastroenterology and Hepatology Medical Center, Cluj-Napoca, Cluj, Romania., Jacques J; Hôpital Dupuytren, Servìce de Gastroentérologie, Limoges, France., Lajin M; Sharp HealthCare, San Diego, California, United States., Desai P; Department of Gastroenterology, Endoscopy Unit, SIDS Hospitals, Surat, India., Shrigiriwar A; Johns Hopkins Medicine, Baltimore, Maryland, United States., Bejjani M; Johns Hopkins Medicine, Baltimore, Maryland, United States., Kumta NA; Icahn School of Medicine at Mount Sinai, New York, New York, United States., Khashab MA; Johns Hopkins Medicine, Baltimore, Maryland, United States. |
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| Jazyk: | angličtina |
| Zdroj: | Endoscopy [Endoscopy] 2023 Jun; Vol. 55 (6), pp. 501-507. Date of Electronic Publication: 2023 Feb 24. |
| DOI: | 10.1055/a-2025-0715 |
| Abstrakt: | Background: Zenker's diverticulum peroral endoscopic myotomy (zPOEM) is a minimally invasive treatment strategy for Zenker's diverticulum, with excellent results for management of small-to-moderate Zenker's diverticulum. We evaluated its use in the management of large Zenker's diverticulum. Methods: This was a retrospective multicenter cohort study across 11 international centers including adult patients with large Zenker's diverticulum ≥ 40 mm treated by zPOEM between March 2017 and March 2022. The primary outcome was clinical success (dysphagia score ≤ 1 without need for further intervention). Secondary outcomes included technical success (complete myotomy as intended), adverse events (AEs), and rate of recurrence. Results: 83 patients (male 62.7 %, mean age 72.6 [SD 11.5] years) underwent zPOEM for treatment of large Zenker's diverticulum (median size 50 mm, interquartile range [IQR] 41-55 mm, range 40-80 mm). The zPOEM procedure was technically successful in 82 patients (98.8 %), with a mean procedure time of 48.7 (SD 23.2) minutes. Clinical success was achieved in 71 patients (85.5 %). Median (IQR) symptom scores improved significantly from baseline for dysphagia (2 2 3 vs. 0 [0-2]; P < 0.001), regurgitation (3 2 3 4 vs. 0 [0-0]; P < 0.001), and respiratory symptoms (2 [0-3] vs. 0 [0-0]; P < 0.001). Among patients achieving clinical success, only one recurrence (1.4 %) was recorded during a median follow-up of 12.2 months (IQR 3-28). Post-procedure AEs, all mild to moderate, occurred in four patients (4.8 %). Conclusion: This study demonstrated safe and effective use of zPOEM in the management of large Zenker's diverticulum. Competing Interests: J. Nieto is a consultant for Boston Scientific, Olympus, and ConMed. M. Ujiki is a board member for Boston Scientific, a consultant for Olympus and Cook, and has received grant funding from Medtronic and payments for lectures from Medtronic, Erbe, and Gore. R.E. Kim is a consultant for Medtronic and Cook Medical. N.A. Kumta is a consultant for Apollo Endosurgery, Boston Scientific, Olympus, Intuitive Surgical, and SafeHeal. M.A. Khashab is a consultant for Boston Scientific, Olympus America, Medtronic, Apollo Endosurgery, Pentax, and GI Supply; he also receives royalties from UpToDate and Elsevier. L.Y. Zhang, O. Hernandez Mondragon, M. Pioche, S.N. Steinway, V.N. VanDruff, A. Canakis, M. Tantau, A. Tantau, A. Pop, J. Jacques, M. Lajin, P. Desai, A. Shrigiriwar, and M. Bejjani declare that they have no conflict of interest. (Thieme. All rights reserved.) |
| Databáze: | MEDLINE |
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