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Endoscopy 2020; 52(07): 563-568
DOI: 10.1055/a-1127-3304
Original article

Peroral endoscopic septotomy for short-septum Zenker’s diverticulum

Alessandro Repici
 1   Department of Gastroenterology, Digestive Endoscopy Unit, Humanitas Clinical and Research Center, Rozzano, Italy
 2   Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
,
Marco Spadaccini
 1   Department of Gastroenterology, Digestive Endoscopy Unit, Humanitas Clinical and Research Center, Rozzano, Italy
 2   Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
,
Paul James Belletrutti
 2   Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
,
Piera Alessia Galtieri
 1   Department of Gastroenterology, Digestive Endoscopy Unit, Humanitas Clinical and Research Center, Rozzano, Italy
,
Alessandro Fugazza
 1   Department of Gastroenterology, Digestive Endoscopy Unit, Humanitas Clinical and Research Center, Rozzano, Italy
,
Andrea Anderloni
 1   Department of Gastroenterology, Digestive Endoscopy Unit, Humanitas Clinical and Research Center, Rozzano, Italy
,
Silvia Carrara
 1   Department of Gastroenterology, Digestive Endoscopy Unit, Humanitas Clinical and Research Center, Rozzano, Italy
,
Milena Di Leo
 2   Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
,
Gaia Pellegatta
 1   Department of Gastroenterology, Digestive Endoscopy Unit, Humanitas Clinical and Research Center, Rozzano, Italy
,
Annalisa Cappello
 1   Department of Gastroenterology, Digestive Endoscopy Unit, Humanitas Clinical and Research Center, Rozzano, Italy
,
Carlo Castoro
 2   Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
,
Yervant Ichkhanian
 3   Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, United States
,
Mouen A. Khashab
 3   Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, United States
,
Roberta Maselli
 1   Department of Gastroenterology, Digestive Endoscopy Unit, Humanitas Clinical and Research Center, Rozzano, Italy
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Abstract

Background Treatments of Zenker’s diverticulum aim to dissect the cricopharyngeal muscle, removing the underlying source of dysfunction. This is difficult in patients with a short-septum (≤ 20 mm) diverticulum because the limited anatomical space restricts the operating area for either rigid or flexible endoscopic approaches. The aim of this study was to investigate the efficacy and safety of a novel third-space approach, peroral endoscopic septotomy (POES), for treating symptomatic patients with short-septum Zenker’s diverticulum.

Methods All patients with short-septum Zenker’s diverticulum who were referred for endoscopic repair from September 2017, were considered for the study. Outcomes included procedure-related adverse events and symptom improvement. The Dakkak – Bennett score was used to quantify dysphagia.

Results 20 patients (men 12, women 8; mean age 67.9 years [SD 14.3]) underwent POES. All procedures were performed with patients under deep sedation. Mean size of Zenker’s diverticulum was 17.5 mm (SD 3.0) and mean dysphagia score was 2.7 (SD 0.5). Average procedure time was 13.8 minutes (SD 5.1). No intra- or post- procedural adverse events occurred. Septal myotomy was successfully completed in all patients. Dysphagia significantly improved in 19 out of 20 patients. Dakkak – Bennett score improved to 0.3 (SD 0.5), P < 0.0001). No recurrences were reported in a mean follow-up time of 12.0 months (SD 3.7, range 6 – 20).

Conclusions POES may be considered as a potential alternative for the treatment of short-septum Zenker’s diverticulum. Further data are required to validate this technique and compare it with already available rigid and flexible approaches.



Publication History

Received: 10 October 2019

Accepted: 10 February 2020

Article published online:
17 March 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

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