Rouquette Olivier, Abergel Armando, Mulliez Aurélien, Poincloux Laurent
Olivier Rouquette, Armando Abergel, Laurent Poincloux, Department of Digestive and Hepatobiliary Diseases, CHU Estaing Clermont-Ferrand, 63003 Clermont-Ferrand, France.
World J Gastrointest Endosc. 2017 Aug 16;9(8):411-416. doi: 10.4253/wjge.v9.i8.411.
To investigate the outcome of flexible endoscopic myotomy performed with the Hook knife in patients with symptomatic Zenker's diverticulum (ZD).
All consecutive patients treated for ZD at our institution between 7/2012 and 12/2016 were included. The flexible endoscopic soft diverticuloscope-assisted technique with endoclips placement and Hook knife myotomy were performed in all patients. Here we report a retrospective review of prospectively collected data. Demographics, dysphagia score (Dakkak and Bennett), associated symptoms and adverse events were collected pre-procedure, at 2 and 6 mo post-procedure, and at the end of the follow-up period. Clinical success was defined as at least 1-point improvement in dysphagia score and a residual dysphagia score ≤ 1, with no need for reintervention. Dysphagia scores were compared before treatment and at end-of-follow-up using the Wilcoxon test.
Twenty-four patients were included. Mean size of ZD was 3.0 cm (range 2-8 cm). Mean number of sessions was 1.17/patient (range 1-3 sessions). Overall clinical success was 91.7%. Two adverse events (8.3%) occurred, and both were managed conservatively. No bleeding or perforation was reported. Mild pain was reported by 9 patients (37.5%). Median hospital stay was 1 d (range 1-6). Median follow-up was 19.5 mo (range 6-53). Mean ± SD dysphagia score was 2.25 ± 0.89 before treatment and decreased to 0.41 ± 0.92 at end-of-follow-up ( < 0.001). Regurgitation and cough dropped from 91.7% and 50% to 12.5% and 0% at the end of follow-up, respectively. Recurrence was observed in 3 patients, and all 3 were symptom-free after one more session.
The Hook knife, used in the soft diverticuloscope-assisted technique setting, is efficient and safe for treatment of ZD.
探讨使用钩刀行柔性内镜下肌切开术治疗有症状的Zenker憩室（ZD）患者的疗效。
纳入2012年7月至2016年12月在本机构接受ZD治疗的所有连续患者。所有患者均采用柔性内镜软憩室镜辅助技术并放置内镜夹及使用钩刀行肌切开术。在此我们报告对前瞻性收集的数据进行的回顾性分析。收集患者术前、术后2个月和6个月以及随访期末的人口统计学资料、吞咽困难评分（Dakkak和Bennett评分）、相关症状及不良事件。临床成功定义为吞咽困难评分至少改善1分且残余吞咽困难评分≤1分，无需再次干预。采用Wilcoxon检验比较治疗前和随访期末的吞咽困难评分。
共纳入24例患者。ZD的平均大小为3.0 cm（范围2 - 8 cm）。平均手术次数为1.17次/患者（范围1 - 3次）。总体临床成功率为91.7%。发生2例不良事件（8.3%），均经保守治疗处理。未报告出血或穿孔情况。9例患者（37.5%）报告有轻度疼痛。中位住院时间为1天（范围1 - 6天）。中位随访时间为19.5个月（范围6 - 53个月）。治疗前平均±标准差吞咽困难评分为2.25 ± 0.89，随访期末降至0.41 ± 0.92（P < 0.001）。随访期末反流和咳嗽分别从91.7%和50%降至12.5%和0%。观察到3例复发，再次手术后所有3例均无症状。
在软憩室镜辅助技术中使用钩刀治疗ZD有效且安全。
