Cai Mingyan, Xu Meidong, Li Quanlin, Chen Weifeng, Zhu Yan, Zhang Danfeng, Yao Liqing, Zhou Pinghong
Department of Endoscopy Center, Zhongshan Hospital, Fudan University; Endoscopy Research Institute, Fudan University; Shanghai Endoscopy Diagnosis and Treatment Engineering Technology Research Center, Shanghai 200032, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2017 May 25;20(5):530-534.
To evaluate the safety and efficacy of submucosal tunneling endoscopic septum division (STESD) for escophageal diverticulum.
Clinical data of six consecutive patients with symptomatic esophageal diverticula who received STESD in Endoscopy Center of Zhongshan Hospital, Fudan University from April 2016 to November 2016 were analyzed retrospectively. STESD was performed as following: mucosal entry was made 3 cm from the septum of esophageal diverticulum; submucosal tunnel was created towards the septum; after the satisfactory exposure of the septum, endoscopic division was made down to the bottom of the diverticulum; mucosal closure of the tunnel entry was made. The symptoms were scored using a system modified according to Eckardt score, namely dysphagia, heartburn, regurgitation, weight loss and retrosternal pain with each ranging from 0 to 3 (maximum score 15, minimum score 0, the higher the score, the more severe the symptoms).
There were four males and two females with median age of 56.5 (range 50-67) years. Four patients were epiphrenic diverticula, and the other two were Zenker's diverticula. Median duration of disease was 2.5 years (range 5 months-29 years). No previous treatment was attempted. All the patients completed STESD successfully. The median septum division length was 2.5(1-4) cm. The median number of metallic clips for mucosal closure was 5(2-6). The median operation time was 51.5 (33-135) min. No major adverse events, such as perforation or bleeding were found in perioperative period. The median time of hospital stay was 5(3-9) days. All the patients had symptom relief after operation. One patient with Zenker's diverticulum reported foreign body sensation after operation and experienced relief two weeks afterwards. During a median follow-up time of 5(4-10) months, the median symptom score of 6 cases was 4.5 (1-13) before and 0.5 (0-4) after operation. The symptom scores went down to zero in 3 patients (preoperative scores 13, 1, 1, respectively), and down to 1 in 2 patients with main symptom of backflow (preoperative scores 5, 4, respectively). One patient with 29 years history of disease did not report obvious improvement in symptoms (preoperative and postoperative scores 5, 4, respectively).
Submucosal tunneling endoscopic septum division is efficient and safe to relieve symptomatic esophageal diverticulum in short term.
评估黏膜下隧道内镜下食管隔切开术（STESD）治疗食管憩室的安全性和有效性。
回顾性分析2016年4月至2016年11月在复旦大学附属中山医院内镜中心接受STESD治疗的6例有症状食管憩室患者的临床资料。STESD操作如下：在距食管憩室隔3 cm处做黏膜切口；向隔方向建立黏膜下隧道；在隔充分暴露后，内镜下切开至憩室底部；封闭隧道入口黏膜。采用根据Eckardt评分修改的系统对症状进行评分，即吞咽困难、烧心、反流、体重减轻和胸骨后疼痛，每项评分范围为0至3分（最高分15分，最低分0分，分数越高症状越严重）。
6例患者中男性4例，女性2例，中位年龄56.5岁（范围50 - 67岁）。4例为膈上憩室，另外2例为Zenker憩室。疾病中位病程为2.5年（范围5个月 - 29年）。既往未尝试过治疗。所有患者均成功完成STESD。食管隔切开的中位长度为2.5（1 - 4）cm。黏膜封闭所用金属夹的中位数量为5（2 - 6）个。中位手术时间为51.5（33 - 135）分钟。围手术期未发现穿孔或出血等严重不良事件。中位住院时间为5（3 - 9）天。所有患者术后症状均缓解。1例Zenker憩室患者术后出现异物感，2周后缓解。在中位随访时间5（4 - 10）个月期间，6例患者术前症状中位评分为4.5（1 - 13）分，术后为0.5（0 - 4）分。3例患者症状评分降至零（术前评分分别为13分、1分、1分），2例以反流为主要症状的患者症状评分降至1分（术前评分分别为5分、4分）。1例病程29年的患者症状无明显改善（术前和术后评分分别为5分、4分）。
黏膜下隧道内镜下食管隔切开术在短期内缓解有症状食管憩室有效且安全。
