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DOI: 10.1055/s-0039-1681374
PERORAL ENDOSCOPIC MYOTOMY AND SEPTOTOMY (POEM-S) FOR THE TREATMENT OF EPIPHRENIC ESOPHAGEAL DIVERTICULUM. A PILOT STUDY WITH VIDEO
Publikationsverlauf
Publikationsdatum:
18. März 2019 (online)
Background and aims:
Esophageal diverticula are rare, frequently associated with esophageal dysmotility, and usually managed surgically with high morbidity. We report a series of 6 patients treated by peroral endoscopic submucosal myotomy and septotomy (POEM-S). The objectives were to describe the technique, document its feasibility, safety and clinical efficacy.
Patients and methods:
Patients referred for endoscopic management of epiphrenic diverticulum by POEM-S were included. Procedures where performed in patients intubated with CO2 and regular scopes and using a Triangle knife (Olympus, Japan). The tunnel was started just above the diverticulum, on the posterior wall, passing nearby the diverticular septum and continued up to the stomach (if achalasia). Then an anterograde septotomy was performed continued by a myotomy. Finally the mucosal access was closed with clips. Patients were kept fasting during 12 hours and then resume oral intake (liquid then mixed) in absence of complication. The had a clinical assessment at 3 months with a esophagogram.
Results:
6 patients were included (3 men and 3 women aged between 62 to 83 years). The main symptoms were dysphagia (n = 6), regurgitations (n = 4) and weight loss (n = 4), evolving for a mean of 15 years. Five of them had an achalasia and one a nutcracker esophagus at high resolution manometry. Two already benefited from a regular POEM with cardial myotomy, without success.
All the procedures were completed, without per or post-operative complications. Patients were discharged between 2 and 8 post-operative days. A t 3 months, 5 patients had a clinical resolution of symptoms and resumed a normal diet. All patients had improved their weight. All esophagograms showed a better esophageal clearance and a decreasing of the diverticula's size.
Conclusion:
The POEM-S for treating epiphrenic diverticulas with or without motility disorder is a safe and effective technique that should be considered instead of morbid surgery.