Mucosa-preserving Zenker's diverticulotomy.
Ontology highlight
ABSTRACT:
SUBMITTER: Zhang LY
PROVIDER: S-EPMC7947252 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Background and aimsZenker's diverticulum (ZD) is attributed to a poorly compliant cricopharyngeus muscle, and the mainstay of treatment is a cricopharyngeal myotomy. We present a video series summarizing endoscopic treatment options for ZD and related conditions.MethodsWe review the rationale and key technique for various endoscopic treatment modalities for ZD, cricopharyngeal bar, and other esophageal diverticula.ResultsStandard flexible endoscopic cricopharyngeal myotomy involves the division of the common wall or septum of the ZD, aiming for complete transection of the cricopharyngeus. However, recurrence rates are high, likely owing to incomplete myotomy. Zenker's peroral endoscopic myotomy (Z-POEM) uses a proximal submucosal tunnel to provide direct visualization of the cricopharyngeus and septum, allowing confirmation of complete myotomy. We demonstrate an over-the-septum modification to simplify the technique. Submucosal fibrosis, commonly seen in patients with prior treatment, limits submucosal dissection. We present a hybrid technique to overcome this, whereby a traditional septotomy is performed until submucosal tissue is visualized. The intact mucosal flap after Z-POEM in a large ZD may contribute to residual dysphagia. We propose Z-POEM with mucosotomy for large ZD. Finally, we demonstrate modifications for treatment of other esophageal diseases, including cricopharyngeal bar and non-Zenker's esophageal diverticula.ConclusionEndoscopic treatment options for ZD and related conditions are rapidly expanding. With careful tailoring to individual patient characteristics, our expanding arsenal of options allows effective and safe treatment of a broad spectrum of patients.
| S-EPMC8646134 | biostudies-literature
Project description:We discuss an unusual presentation of Zenker's Diverticulum (ZD). A 76-year-old man presented with a left sided neck mass which was misdiagnosed as a thyroid mass due to the anatomical location and size. The ultrasound and fine needle-aspiration cytology findings were inconclusive, and a CT scan was then considered which reported a large pharyngeal pouch. Our recommendation is to consider an early CT scan in patient's where there is a clinical suspicion or risk factors for the development of pharyngeal pouch specially when the fine-needle aspiration cytology findings are inconclusive. This would reduce the risk of a delayed diagnosis which can prevent potential perforation of the pharyngeal pouch and development of mediastinitis.
| S-EPMC7695926 | biostudies-literature
Project description:Video 1Peroral endoscopic myotomy for a residual Zenker's diverticulum following endoscopic myotomy.
| S-EPMC8755520 | biostudies-literature
Project description:Background and Aims:Zenker's diverticulum is a false diverticulum through Killian's dehiscence. Symptoms include halitosis, dysphagia, regurgitation, cough, and aspiration pneumonia. Treatment options include open transcervical cricopharyngeal myotomy, trans-oral rigid endoscopic stapling, and minimally invasive endoscopic myotomy. Although open surgical techniques have historically been the criterion standard for treatment, endoscopic options have become increasingly used. We propose the use of flexible endoscopy in the management of Zenker's diverticulum. Methods:We present a retrospective case series of 9 patients undergoing endoscopic cricopharyngeal myotomy from 2014 to 2018 using our endoscopic technique. Results:We demonstrate that endoscopic technique provided adequate symptomatic relief in 7 of 9 patients, with no operative adverse events. Conclusions:Cricopharyngeal myotomy using flexible endoscopy is a safe and effective technique for the management of Zenker's diverticulum. Potential benefits of this approach include shorter operative times, shorter postoperative admissions, and earlier progression of diet. Initial treatment with endoscopic technique does not preclude future open repairs.
| S-EPMC6363821 | biostudies-other
Project description:BackgroundPeroral 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 methodsThis 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.Results22 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.ConclusionsThis 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.
| S-EPMC7826711 | biostudies-literature
Project description:A 72-year-old woman presented with long-standing gastro-oesophageal reflux, regurgitation of swallowed food and worsening cervical dysphagia. Fluoroscopic barium oesophagography revealed a posterolateral pharyngeal pouch (Zenker's diverticulum (ZD)) complicating a 'cup and spill' oesophageal deformity with a smoothly tapered segment at the gastro-oesophageal junction. CT and high-resolution manometry confirmed that the underlying abnormality was a massively dilated oesophagus with aperistalsis and pan-oesophageal pressurisation, consistent with a diagnosis of oesophageal achalasia (type II). She underwent endoscopic stapled diverticulotomy, with good symptomatic relief. We discuss the aetiology of ZD, its management and the association here with oesophageal achalasia.
| S-EPMC3863039 | biostudies-other
Project description:The goal of dimensionality reduction is to embed high-dimensional data in a low-dimensional space while preserving structure in the data relevant to exploratory data analysis such as clusters. However, existing dimensionality reduction methods often either fail to separate clusters due to the crowding problem or can only separate clusters at a single resolution. We develop a new approach to dimensionality reduction: tree preserving embedding. Our approach uses the topological notion of connectedness to separate clusters at all resolutions. We provide a formal guarantee of cluster separation for our approach that holds for finite samples. Our approach requires no parameters and can handle general types of data, making it easy to use in practice and suggesting new strategies for robust data visualization.
| S-EPMC3193256 | biostudies-literature
Project description:In the last decade, deep learning has been applied in a wide range of problems with tremendous success. This success mainly comes from large data availability, increased computational power, and theoretical improvements in the training phase. As the dataset grows, the real world is better represented, making it possible to develop a model that can generalize. However, creating a labeled dataset is expensive, time-consuming, and sometimes not likely in some domains if not challenging. Therefore, researchers proposed data augmentation methods to increase dataset size and variety by creating variations of the existing data. For image data, variations can be obtained by applying color or spatial transformations, only one or a combination. Such color transformations perform some linear or nonlinear operations in the entire image or in the patches to create variations of the original image. The current color-based augmentation methods are usually based on image processing methods that apply color transformations such as equalizing, solarizing, and posterizing. Nevertheless, these color-based data augmentation methods do not guarantee to create plausible variations of the image. This paper proposes a novel distribution-preserving data augmentation method that creates plausible image variations by shifting pixel colors to another point in the image color distribution. We achieved this by defining a regularized density decreasing direction to create paths from the original pixels' color to the distribution tails. The proposed method provides superior performance compared to existing data augmentation methods which is shown using a transfer learning scenario on the UC Merced Land-use, Intel Image Classification, and Oxford-IIIT Pet datasets for classification and segmentation tasks.
| S-EPMC8176531 | biostudies-literature
Project description:Video 1Endoscopic vacuum therapy for nonhealing cavity with fistulous tract after peroral endoscopic myotomy for Zenker diverticulum.
| S-EPMC10928134 | biostudies-literature
Project description:Video 1Endoscopic suturing of an obstructing Zenker's diverticulum.
| S-EPMC9263871 | biostudies-literature