Carrica Sebastián Augusto, Martinez Horacio, Correa Gustavo Javier, Yantorno Martin, Tufare Francisco, Baldoni Fernando Tufare, Villaverde Augusto, Chopita Nestor
Acta Gastroenterol Latinoam. 2016 Mar;46(1):22-29.
Zenker's diverticulum (ZD) is an acquired protrusion of the esophageal wall. Treatment is reservedfor symptomatic cases. In Argentina, ZD has historically managed exclusively by surgical intervention. In 1995, Ishioka, et al and Mulder, et a1published their experience using flexible endoscopes for diverticulotomy. Since then, a wide variety ofdifferent techniques have been published. Objetive. To present technique modifications and results ofour center.
We reviewed the database of57patients (36 men), with a mean age of 71.9 years (range 37-98), with symptomatic Zenker ' diverticulum, who underwent endoscopic myotomy, from December 1997 to April 2015. All procedures were performed in our center, by the same endoscopist (HM). The most common symptom was dysphagia (94.7%), which was recorded by a 0-4 score (0=no dysphagia, 1 =solids, 2=semisolids, 3=liquids, 4=saliva). The first nine cases were done exposing the septum with a nasogastric tube, and the others with a soft diverticuloscope. Allprocedures were carried out with the patient under deep sedation, adminis- tered by an anesthesiologist. A myotomy was done in all cases with a needle-knife, using a coagulation current, to prevent bleeding. Clips were placed to close mucosalilaps, decrease the risk of unsuspected perforation and postprocedure bleeding.
Seventy procedures were performed, in 56 patients. One patient was excluded because of incomplete myotomy due to a severe adverse event. Ninety-eight percent ofpatients had resolution or improvement of the dysphagia score, at 30 days. Three patients with regurgitation as their sole complaint completely resolved their symptom. Median follow-up was 25 months (1-99). Thirty-seven patients were followed for at least 1 year and 97.3% showed a favorable outcome. In 13 cases (22.8%) a reintervention was needed, with positive results in all cases. Bleeding occurred in one patient (1.4%), who required surgery. Another patient required surgical intervention due to technical issues. There were no perforations or infections.
Treatment of ZD with flexible endoscope is a safe and effective option, with good long-term results. We need randomized clinical trials comparing different therapeutic options to be able to recommend a definitive strategy. Until then, we suggest using the technique with which each center has the most experience and feels most comfortable performing.
Zenker憩室（ZD）是食管壁的后天性突出。仅对有症状的病例进行治疗。在阿根廷，ZD历来仅通过手术干预进行处理。1995年，Ishioka等人以及Mulder等人发表了他们使用软性内镜进行憩室切开术的经验。从那时起，已发表了各种各样不同的技术。目的：介绍我们中心的技术改进及结果。
我们回顾了1997年12月至2015年4月期间57例（36例男性）有症状的Zenker憩室患者的数据库，这些患者接受了内镜下肌切开术，平均年龄71.9岁（范围37 - 98岁）。所有手术均在我们中心由同一位内镜医师（HM）进行。最常见的症状是吞咽困难（94.7%），采用0 - 4分评分记录（0 =无吞咽困难，1 =固体食物，2 =半固体食物，3 =液体食物，4 =唾液）。前9例通过鼻胃管暴露隔膜进行手术，其余病例使用软性憩室镜进行。所有手术均在患者深度镇静下由麻醉医师实施。所有病例均使用针刀并采用凝固电流进行肌切开术，以防止出血。放置夹子关闭黏膜切口，降低意外穿孔和术后出血的风险。
对56例患者进行了70次手术。1例患者因严重不良事件导致肌切开术不完全而被排除。98%的患者在30天时吞咽困难评分得到缓解或改善。3例以反流为唯一主诉的患者症状完全消失。中位随访时间为25个月（1 - 99个月）。37例患者随访至少1年，97.3%显示预后良好。13例（22.8%）需要再次干预，所有病例结果均为阳性。1例患者（1.4%）发生出血，需要手术治疗。另1例患者因技术问题需要手术干预。未发生穿孔或感染。
使用软性内镜治疗ZD是一种安全有效的选择，长期效果良好。我们需要进行随机临床试验比较不同的治疗方案，以便能够推荐一种明确的策略。在此之前，我们建议使用各中心经验最丰富且操作最熟练的技术。
