Flexible endoscopic clip-assisted Zenker's diverticulotomy: the first case series (with videos)
| Autor: | Saad F. Jazrawi, Linda Tang, Edward Chen, Larry L. Myers, Shou-Jiang Tang |
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| Rok vydání: | 2008 |
| Předmět: |
Male
medicine.medical_specialty genetic structures Zenker Diverticulum Radiography Perforation (oil well) Zenker's diverticulum Surgical Staplers Blunt dissection Medicine Humans Retching Aged Aged 80 and over Esophageal Perforation medicine.diagnostic_test business.industry Esophagoscopes Equipment Design Middle Aged medicine.disease Surgical Instruments Dysphagia Surgery Endoscopy Dissection Otorhinolaryngology Feasibility Studies Female Esophagoscopy medicine.symptom business Follow-Up Studies |
| Zdroj: | The Laryngoscope. 118(7) |
| ISSN: | 1531-4995 |
| Popis: | Background: In treating Zenker's diverticulum (ZD), there are potential risks associated with performing flexible endoscopic diverticulotomy without suturing or stapling. We recently introduced flexible endoscopic clip-assisted diverticulotomy (ECD) in treating ZD by securing the septum prior to dissection. Objective: To evaluate the feasibility and safety of ECD for complete septum dissection. Study Design: Case series at an academic center. Seven consecutive patients (mean age 71 y; range 48–91 y) with symptomatic ZD of various craniocaudal sizes based on radiographic measurements (mean 2.6 cm; range 0.8 cm–4.5 cm) were included. The mean depth of the septum was 1.73 cm (range 0.3 cm–3.1 cm). The mean duration of symptoms was 4.8 years (range 0.5–10 y). Methods: After endoclips were placed on either side of the cricopharyngeal bar, the septum was dissected between these two clips down to the inferior end of the diverticulum with a needle-knife. Procedures including “one-step ECD” (n = 1), “stepwise ECD” (n = 3), and “bottom ECD” (n = 2) were performed based on the septum depth of the ZD during endoscopy. ECD was not performed on one patient due to severe mucosal fragility of the esophageal inlet. Iatrogenic blunt dissection of the septum by the endoscopic hood occurred secondary to patient retching during the procedure. Main outcome measurements were symptom resolution and complications. Results: All patients (n = 6) who underwent ECD had complete resolution of esophageal symptoms at a minimum 6-month follow-up. There were no procedural complications. The patient who did not undergo ECD developed an esophageal perforation. She was managed conservatively without surgical intervention. On follow-up, her dysphagia was completely resolved. Conclusions: ECD is feasible, safe, and effective for complete septum dissection. ECD and endoscopic stapler-assisted diverticulotomy are complimentary rather than competing strategies in approaching ZD. Study limitations include the case series design and limited follow-up period. |
| Databáze: | OpenAIRE |
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