Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, The Netherlands.
Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, The Netherlands.
Endoscopy. 2020 Jul;52(7):600-614. doi: 10.1055/a-1171-3174. Epub 2020 May 27.
ESGE suggests flexible endoscopic treatment over open surgical treatment as first-line therapy for patients with a symptomatic Zenker's diverticulum of any size.Weak recommendation, low quality of evidence, level of agreement 100 %.ESGE recommends that emerging treatments for Zenker's diverticulum, such as Zenker's peroral endoscopic myotomy (Z-POEM) and tunneling, be considered as experimental; these treatments should be offered in a research setting only.Strong recommendation, low quality of evidence, level of agreement 100 %.ESGE recommends against the widespread clinical use of transoral incisionless fundoplication (TIF) as an alternative to proton pump inhibitor (PPI) therapy or antireflux surgery in the treatment of gastroesophageal reflux disease (GERD), because of the lack of data on the long-term outcomes, the inferiority of TIF to fundoplication, and its modest efficacy in only highly selected patients. TIF may have a role for patients with mild GERD who are not willing to take PPIs or undergo antireflux surgery.Strong recommendation, moderate quality of evidence, level of agreement 92.8 %.ESGE recommends against the use of the Medigus ultrasonic surgical endostapler (MUSE) in clinical practice because of insufficient data showing its effectiveness and safety in patients with GERD. MUSE should be used in clinical trials only.Strong recommendation, low quality evidence, level of agreement 100 %.ESGE recommends against the use of antireflux mucosectomy (ARMS) in routine clinical practice in the treatment of GERD because of the lack of data and its potential complications.Strong recommendation, low quality evidence, level of agreement 100 %.ESGE recommends endoscopic cecostomy only after conservative management with medical therapies or retrograde lavage has failed.Strong recommendation, low quality evidence, level of agreement 93.3 %.ESGE recommends fixing the cecum to the abdominal wall at three points (using T-anchors, a double-needle suturing device, or laparoscopic fixation) to prevent leaks and infectious adverse events, whatever percutaneous endoscopic cecostomy method is used.Strong recommendation, very low quality evidence, level of agreement 86.7 %.ESGE recommends considering endoscopic decompression of the colon in patients with Ogilvie's syndrome that is not improving with conservative treatment.Strong recommendation, low quality evidence, level of agreement 93.8 %.ESGE recommends prompt endoscopic decompression if the cecal diameter is > 12 cm and if the Ogilvie's syndrome exists for a duration of longer than 4 - 6 days.Strong recommendation, low quality evidence, level of agreement 87.5 %.
ESGE 建议对任何大小的 Zenker 憩室症状患者采用灵活的内镜治疗作为一线治疗。弱推荐，低质量证据，一致性水平 100%。ESGE 建议将 Zenker 经口内镜肌切开术 (Z-POEM) 和隧道等新兴 Zenker 憩室治疗方法视为实验性治疗；这些治疗方法仅应在研究环境中提供。强烈推荐，低质量证据，一致性水平 100%。ESGE 建议不要广泛将经口无切口胃底折叠术 (TIF) 作为质子泵抑制剂 (PPI) 治疗或抗反流手术的替代方法用于治疗胃食管反流病 (GERD)，因为长期结果数据缺乏、TIF 劣于胃底折叠术以及其在仅高度选择的患者中效果中等。TIF 可能适用于不愿服用 PPI 或接受抗反流手术的轻度 GERD 患者。强烈推荐，中等质量证据，一致性水平 92.8%。ESGE 建议不要在临床实践中使用 Medigus 超声外科吻合器 (MUSE)，因为缺乏 GERD 患者有效性和安全性的数据。MUSE 只能在临床试验中使用。强烈推荐，低质量证据，一致性水平 100%。ESGE 建议不要在常规临床实践中使用抗反流黏膜切除术 (ARMS) 治疗 GERD，因为缺乏数据和潜在的并发症。强烈推荐，低质量证据，一致性水平 100%。ESGE 建议仅在保守治疗（包括药物治疗或逆行灌洗）失败后才进行经内镜盲肠造口术。强烈推荐，低质量证据，一致性水平 93.3%。ESGE 建议无论采用何种经皮内镜盲肠造口术方法，都应将盲肠固定在腹壁上的三个点（使用 T 型锚、双针缝合装置或腹腔镜固定），以防止漏液和感染等不良事件。强烈推荐，极低质量证据，一致性水平 86.7%。ESGE 建议在 Ogilvie 综合征患者经保守治疗后仍未改善时，考虑进行结肠内镜减压。强烈推荐，低质量证据，一致性水平 93.8%。ESGE 建议如果盲肠直径>12cm 且 Ogilvie 综合征持续时间超过 4-6 天，应立即进行内镜减压。强烈推荐，低质量证据，一致性水平 87.5%。
