Battaglia Giorgio, Antonello Alessandro, Realdon Stefano, Cesarotto Martina, Zanatta Lisa, Ishaq Sauid
Digestive Endoscopy Unit, Veneto Institute of Oncology IOV IRCSS, Padova.
Department of Surgery, Santa Maria del Prato Hospital, Feltre, Italy.
Dig Endosc. 2015 Nov;27(7):728-33. doi: 10.1111/den.12490. Epub 2015 Jun 26.
Flexible endoscopic septum division is becoming a prominent treatment option for Zenker's diverticulum (ZD). Over the years, various techniques have been developed and many cutting tools have been tested with varying results. We report our experience with a recently designed, monopolar, rotating, scissor-shaped device (SB Knife).
Data on 31 consecutive patients that underwent flexible endoscopic treatment for ZD with the use of the SB Knife were retrieved. Dysphagia, regurgitation, and respiratory symptom severity before the procedure were graded. Procedure duration, rate of complications, symptom changes after the procedure and rate of relapsing patients during follow up were recorded.
The procedure was carried out successfully in all patients. Median procedure time was 14 min. One case of late-onset bleeding developed 1 week after the procedure, and was managed endoscopically. A significant symptom improvement was achieved (dysphagia: median score <3, median score >0, P < 0.001; regurgitation: median score <2, median score >0, P < 0.001; respiratory symptoms: median score <2, median score >0, P = 0.009). Two patients had mild relapsing symptoms, respectively, after 4 and 9 months from the procedure but refused further treatment.
Endoscopic treatment of ZD using this new device is safe and efficient at short term follow up. No perforations were observed and there was a substantial reduction of symptoms after the treatment. Larger studies are needed to fully assess advantages of this new device for endoscopic treatment of ZD.
柔性内镜下隔膜切开术正成为治疗Zenker憩室（ZD）的一种重要方法。多年来，已开发出各种技术，并测试了许多切割工具，结果各异。我们报告了使用一种新设计的单极旋转剪刀形装置（SB刀）的经验。
检索了31例连续使用SB刀进行柔性内镜治疗ZD患者的数据。对术前吞咽困难、反流和呼吸症状的严重程度进行分级。记录手术时间、并发症发生率、术后症状变化以及随访期间复发患者的比例。
所有患者手术均成功完成。手术中位时间为14分钟。1例患者术后1周出现迟发性出血，经内镜处理。症状有显著改善（吞咽困难：中位评分从>0降至<3，P<0.001；反流：中位评分从>0降至<2，P<0.001；呼吸症状：中位评分从>0降至<2，P=0.009）。2例患者分别在术后4个月和9个月出现轻度复发症状，但拒绝进一步治疗。
使用这种新装置进行内镜治疗ZD在短期随访中是安全有效的。未观察到穿孔，治疗后症状明显减轻。需要更大规模的研究来全面评估这种新装置在内镜治疗ZD中的优势。
