Outcomes after per-oral endoscopic myotomy for Zenker's diverticula (Z-POEM) and correlation with impedance planimetry (FLIP).

Autor: Che SYW; Department of Surgery, NorthShore University Health System, GCSI Suite B665, 2650 Ridge Ave, Evanston, IL, 60201, USA. Sche@northshore.org., Joseph S; Department of Surgery, NorthShore University Health System, GCSI Suite B665, 2650 Ridge Ave, Evanston, IL, 60201, USA., Kuchta K; Department of Surgery, NorthShore University Health System, GCSI Suite B665, 2650 Ridge Ave, Evanston, IL, 60201, USA., Amundson JR; Department of Surgery, NorthShore University Health System, GCSI Suite B665, 2650 Ridge Ave, Evanston, IL, 60201, USA.; Department of Surgery, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL, 60637, USA., VanDruff VN; Department of Surgery, NorthShore University Health System, GCSI Suite B665, 2650 Ridge Ave, Evanston, IL, 60201, USA.; Department of Surgery, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL, 60637, USA., Ishii S; Department of Surgery, NorthShore University Health System, GCSI Suite B665, 2650 Ridge Ave, Evanston, IL, 60201, USA., Zimmermann CJ; Department of Surgery, NorthShore University Health System, GCSI Suite B665, 2650 Ridge Ave, Evanston, IL, 60201, USA., Hedberg HM; Department of Surgery, NorthShore University Health System, GCSI Suite B665, 2650 Ridge Ave, Evanston, IL, 60201, USA., Ujiki MB; Department of Surgery, NorthShore University Health System, GCSI Suite B665, 2650 Ridge Ave, Evanston, IL, 60201, USA.; Department of Surgery, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL, 60637, USA.
Jazyk: angličtina
Zdroj: Surgical endoscopy [Surg Endosc] 2024 Feb; Vol. 38 (2), pp. 957-963. Date of Electronic Publication: 2023 Nov 07.
DOI: 10.1007/s00464-023-10512-0
Abstrakt: Introduction: Zenker's diverticulum (ZD) is a false pulsion diverticulum of the cervical esophagus. It is typically found in older adults and manifests with dysphagia. The purpose of this study is to describe our experience with Per-oral endoscopic myotomy for Zenker's (Z-POEM) and intraoperative impedance planimetry (FLIP).
Methods: We performed a single institution retrospective review of patients undergoing Z-POEM in a prospective database between 2014 and 2022. Upper esophageal sphincter (UES) distensibility index (DI, mm 2 /mmHg) was measured by FLIP before and after myotomy. The primary outcome was clinical success. Secondary outcomes included technical failure, adverse events, and quality of life as assessed by the gastroesophageal health-related quality of life (GERD-HRQL), reflux severity index (RSI), and dysphagia score. A statistical analysis of DI was done with the paired t-test (p < 0.05).
Results: Fifty-four patients underwent Z-POEM, with FLIP measurements available in 30 cases. We achieved technical success and clinical success in 54/54 (100%) patients and 46/54 patients (85%), respectively. Three patients (6%) experienced contained leaks. Three patients were readmitted: one for aforementioned contained leak, one for dysphagia, and one post-operative pneumonia. Three patients with residual dysphagia underwent additional endoscopic procedures, all of whom had diverticula > 4 cm. Following myotomy, mean DI increased by 2.0 ± 1.7 mm 2 /mmHg (p < 0.001). In those with good clinical success, change in DI averaged + 1.6 ± 1.1 mm 2 /mmHg. Significant improvement was found in RSI and GERD-HRQL scores, but not dysphagia score.
Conclusion: Z-POEM is a safe and feasible for treatment of ZD. We saw zero cases of intraoperative abandonment. We propose that large diverticula (> 4 cm) are a risk factor for poor outcomes and may require additional endoscopic procedures. An improvement in DI is expected after myotomy, however, the ideal range is still not known.
(© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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