Tu1643 5 - Year Data of a European Tertiary Referral Center on Endoscopic Diverticulotomy in Esophageal Diverticula

Autor: Sandra Meinzer, Liebwin Gossner, Johannes Huber, J Kunz, AK Maier, C Vetter, A Lutterer, B Köhrer, Sandra De Filippo, D Brenke
Rok vydání: 2012
Předmět:
Zdroj: Gastrointestinal Endoscopy. 75:AB474
ISSN: 0016-5107
DOI: 10.1016/j.gie.2012.03.1289
Popis: 5 Year Data of a European Tertiary Referral Center on Endoscopic Diverticulotomy in Esophageal Diverticula Sandra Meinzer*, Sandra De Filippo, Christine Vetter, Anne-Katrin Maier, Johannes Huber, Johannes Kunz, Dirk Brenke, Bernd Kohrer, Achim Lutterer, Liebwin Gossner II. Med. Klinik, Stadtisches Klinikum Karlsruhe, Karlsruhe, Germany While not a common disease, esophageal diverticula still highly impair quality of every day life. As most patients diagnosed are elderly, surgical myotomy may often seem to risky in face of comorbidity. To evaluate all patients presenting with esophageal diverticula in the last 5 years and to establish patient’ s characteristics, technical succes, complications as well as outcome.Evaluation for endoscopic treatment included symptom assessment (qualitative and quantitative) and diagnostic egd. If found suitable, diverticulotomy was performed immediately. Mucosal incision was achieved using argon plasma coagulation. In cases of large diverticula, a second session was required on the following day. Keeping in mind a conservative approach, retherapy was limited to patients with persistent symptoms after subtotal diverticulotomy.During the last 5 years a total of 30 patients ( 54 % male, 46% female, median follow up 20.7 11.2 months ) diagnosed with esophageal diverticula presented in our endoscopy unit. 29 patients had refused previous offers of therapy due to age (76.6% over 70 years old, median age 76.2 years 9.8 years), comorbidity or patient’ s concerns over possible complications. Only one patient had undergone previous surgery. On initial evaluation 27 patients were found to be elective to endoscopic therapy. The other three were excluded because of minimal symptoms, type (traction diverticulum) and complex anatomy (several, medium sized diverticula localized in the mid and lower esophagus). Adequate symptom reduction could be achieved in all treated patients (41 diverticulotomies in total, mean 1.5 sessions/patients, 9 patients requiring retherapy) independent of initial symptom severity. However, some responded better to endoscopic therapy than others (symptom redurctin: dysphagia 72.6% vs. regurgitation 28% ), implying alternative mechanisms of symptom origin. Endoscopic diverticulotomy can be safely applied even to the very elderly while still guaranteeing satisfying results. Treatment success does not primarly depend on use of endoscopic accesoires such as a diverticuloscope, needle knife or argon plasma probe but is determined by the endoscopist’ s experience in patient selection in whom to attain maximal incision depth while simultaneously maintaining minimal complication risk.
Databáze: OpenAIRE
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