Cricopharyngomyotomy: Outcomes of flexible endoscopic management of small and medium sized Zenker's diverticulum.

IF 2.7 3区医学 Q1 SURGERY American journal of surgery Pub Date : 2024-12-01 Epub Date: 2024-07-02 DOI:10.1016/j.amjsurg.2024.115823

Alexis M Holland, William R Lorenz, Ansley B Ricker, Brittany S Mead, Gregory T Scarola, Paul D Colavita

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Abstract

Background: Zenker's diverticulum (ZD) was historically treated with an open transcervical myotomy with diverticulectomy, but endoscopic approaches have gained popularity, though with little recent data. This study aimed to report flexible endoscopic cricopharyngomyotomy (FEC) outcomes, particularly in smaller diverticula.

Methods: Patients with ZD treated with FEC at a tertiary center were reviewed. Patients were grouped by diverticulum size: small (sZD)≤1.5 cm; medium (mZD) > 1.5 cm.

Results: Of 30 patients, median age, BMI, sex, and comorbidities were similar between sZD (n = 18) and mZD (n = 12). Overall, 80.0 % had the procedure performed with a needle knife. Median number of clips for mucosotomy closure (5.0[5.0,6.0]vs.7.0[5.0,7.0]clips;p = 0.051), operative time (59.5[51.0,75.0]vs.74.5[51.0,93.5]minutes;p = 0.498), length-of-stay (1.0[1.0,1.0]vs.1.0[1.0,1.0]days;p = 0.397), and follow-up (20.8[1.1,33.4]vs.15.6[5.4,50.4]months;p = 0.641) were comparable. There were no postoperative leaks; incomplete myotomy occurred in one sZD, yielding a clinical success rate of 96.7 %.

Conclusions: FEC has a high success rate for ZD and an advantage in small diverticula, difficult to treat with stapling or open technique.

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环咽切开术：灵活的内窥镜治疗中小型 Zenker 胃窦憩室的效果。

背景：禅克氏憩室（Zenker's diverticulum，ZD）历来采用开放式经颈部肌层切开术和憩室切除术进行治疗，但内窥镜方法越来越受欢迎，不过近期数据很少。本研究旨在报告柔性内镜环咽肌切开术（FEC）的疗效，尤其是对较小的憩室的疗效：方法：研究人员回顾了在一家三级医疗中心接受柔性内镜环咽切开术治疗的憩室畸形患者。根据憩室大小对患者进行分组：小憩室（sZD）≤1.5厘米；中憩室（mZD）>1.5厘米：在30名患者中，sZD（18人）和mZD（12人）的中位年龄、体重指数、性别和合并症相似。总体而言，80.0%的患者使用针刀进行手术。粘膜切口闭合夹的中位数（5.0[5.0,6.0]vs.7.0[5.0,7.0]夹；P = 0.051）、手术时间（59.5[51.0,75.0]vs.74.5[51.0,93.5]分钟；p = 0.498）、住院时间（1.0[1.0,1.0]vs.1.0[1.0,1.0]天；p = 0.397）和随访时间（20.8[1.1,33.4]vs.15.6[5.4,50.4]个月；p = 0.641）相当。术后无漏液；1 例 sZD 发生不完全肌切开术，临床成功率为 96.7%：结论：腹腔镜憩室切除术治疗憩室的成功率很高，对于难以用订书机或开腹技术治疗的小憩室具有优势。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.