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Mucosa-preserving Zenker's diverticulotomy.

ABSTRACT:

SUBMITTER: Zhang LY

PROVIDER: S-EPMC7947252 | biostudies-literature | 2021 Mar

REPOSITORIES: biostudies-literature

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Mucosa-preserving Zenker's diverticulotomy.

Zhang Linda Yun LY Ngamruengphong Saowanee S

VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy 20201213 3

PMID: 33738355

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Characterizing a CT esophagram protocol after flexible endoscopic diverticulotomy for Zenker's diverticulum: a retrospective series.

Project description:BackgroundFlexible endoscopic cricopharyngeal myotomy and septotomy offer a minimally invasive transluminal option for the treatment of symptomatic Zenker's diverticulum (ZD). There is currently no consensus regarding postoperative follow-up imaging. We suggest a standardized computed tomography (CT) esophagram protocol for radiographic evaluation of postoperative findings.MethodsSingle center retrospective analysis of patients with symptomatic ZD who underwent flexible endoscopic diverticulotomy and postoperative imaging with CT esophagram from January 2015 to March 2020. An experienced radiologist blinded to the initial imaging reports prospectively interpreted all CT esophagram findings, in order to minimize bias.ResultsTwenty-one patients underwent CT esophagram following flexible endoscopic diverticulotomy for ZD. Diverticulotomy was technically successful in all patients. Most common findings on imaging included: atelectasis (13/21; 62%), persistent esophageal diverticulum (7/21; 33%), pneumomediastinum (3/21; 14%), aspiration (2/21; 10%), and extraluminal air and contrast extravasation consistent with focal esophageal perforation (1/21; 5%).ConclusionsWe describe a standardized, simple, and accessible CT esophagram protocol for postoperative imaging of patients with post-flexible endoscopic cricopharyngeal myotomy and septotomy for ZD. CT esophagram facilitates a definitive exclusion of focal esophageal perforation as a postoperative complication of flexible endoscopic diverticulotomy by ruling out extraluminal air and contrast extravasation.

| S-EPMC9469010 | biostudies-literature

Carbon dioxide laser versus stapler-assisted endoscopic Zenker's diverticulotomy: a systematic review and meta-analysis.

Project description:To evaluate outcomes following endoscopic management of Zenker's diverticula using a carbon dioxide laser (CO2) or stapler-assisted technique, a systematic review and meta-analysis were conducted. Seven retrospective, uncontrolled case series including 391 procedures met selection criteria. No higher quality studies were identified. Outcomes favoring the stapler technique included a shorter duration of nil per os (NPO) status (2 studies), length of hospitalization (LOH, 2 studies), and fewer postoperative fevers and abnormal chest x-rays (1 study). Outcomes favoring the CO2 technique included greater improvement in postoperative dysphagia and regurgitation scores (2 studies) and a lower revision rate (1 study). Meta-analysis demonstrated increased nondental complications in the CO2 group (odds ratio 3.81; 95% confidence interval, 1.37-10.59; P = .01) but no difference in duration of NPO (P = .06), LOH (P = .07), overall complications (P = .08), dental complications (P = .57), major complications (P = .38), or revision surgery (P = .82). Implications are limited by the quality of studies identified.

| S-EPMC5560916 | biostudies-other

Open Zenker's-peroral endoscopic myotomy: novel treatment for Zenker's diverticulum.

Project description: Not available

| S-EPMC11652090 | biostudies-literature

Zenker's diverticulum: advancing beyond the tunnel.

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

Flexible endoscopic management of Zenker's diverticulum.

Project description: Not available

| S-EPMC5965726 | biostudies-literature

Management of Zenker's diverticulum using flexible endoscopy.

Project description:Background and aimsZenker'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.MethodsWe present a retrospective case series of 9 patients undergoing endoscopic cricopharyngeal myotomy from 2014 to 2018 using our endoscopic technique.ResultsWe demonstrate that endoscopic technique provided adequate symptomatic relief in 7 of 9 patients, with no operative adverse events.ConclusionsCricopharyngeal 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-literature

Endoscopic treatment of Killian-Jamieson diverticulum using submucosal tunneling diverticulotomy technique.

Project description: Not available

| S-EPMC7649836 | biostudies-literature

Novel endoscopic scissors for the treatment of Zenker's diverticulum.

Project description: Not available

| S-EPMC5990872 | biostudies-literature

Novel technique for flexible endoscopic repair of Zenker's diverticulum.

Project description: Not available

| S-EPMC5989163 | biostudies-literature

Zenker's diverticulum misinterpreted as a thyroid mass: Case report.

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

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