Cleveland Clinic, 9500 Euclid Ave Mail Code H18, Cleveland, OH, 44195-0001, USA.
Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
Surg Endosc. 2021 Jul;35(7):3896-3904. doi: 10.1007/s00464-020-07861-5. Epub 2020 Aug 6.
In peroral endoscopic myotomy for Zenker's diverticulum (Z-POEM), the cricopharyngeus muscle is divided within a submucosal tunnel started in the hypopharynx. We aimed to evaluate the safety and preliminary outcomes in patients who underwent a modified version of the Z-POEM where the tunnel is made directly overlying the cricopharyngeus, the mucosal incision and muscular interruption (MIMI) approach, and to compare these with patients who underwent a non-tunneled flexible endoscopic approach.
All patients with ZD who were treated by flexible endoscopy at our institution between January 2015 and February 2020 were identified by a retrospective chart review. Dysphagia symptoms were assessed using a validated scoring system.
Nineteen patients with ZD underwent MIMI (mean age 76.1 years, 68.1% male) and seven patients underwent non-tunneled flexible endoscopic approach (mean age 64.4 years, 85.7% male) during the study period. Mean ZD size was 2.8 cm in the MIMI group and 1.9 cm in the non-tunneled group (p = 0.03). Clinical success was achieved in 17/19(89.5%) MIMI patients and 7/7(100%) of non-tunneled flexible endoscopic patients (p = 0.101). Dysphagia scores improved in both groups, although this difference was only significant in the MIMI group (p ≤ 0.001). Recurrence occurred in 2/17(11.7%) MIMI patients and 3/7(42.9%) non-tunneled flexible endoscopic patients (p = 0.096). There were 4 complications, including one pharyngeal perforation requiring open surgical repair in a patient with a small ZD with an associated cricopharyngeal bar in the MIMI group. Median length of follow-up was 290 [142; 465] days in the MIMI group and 1056 [258; 1206] days in the non-tunneled group (p = 0.094).
MIMI is a technically feasible and effective treatment for ZD. Care should be taken in patients with a cricopharyngeal bar and small ZD, as this may increase the risk of perforation. Larger studies with long-term follow-up are needed to determine if MIMI reduces the risk of symptom recurrence when compared to non-tunneled flexible endoscopic approaches.
在经口内镜肌切开术（POEM）治疗Zenker 憩室（Z-POEM）中，将环咽肌切开于从下咽开始的黏膜下隧道内。我们旨在评估改良 Z-POEM （MIMI）的安全性和初步结果，其中隧道直接位于环咽肌上方，黏膜切开和肌肉中断（MIMI）方法，并将其与接受非隧道式灵活内镜方法的患者进行比较。
通过回顾性图表审查，确定了 2015 年 1 月至 2020 年 2 月期间在我院接受 ZD 治疗的所有患者。使用经过验证的评分系统评估吞咽困难症状。
研究期间，19 例 ZD 患者接受 MIMI（平均年龄 76.1 岁，68.1%为男性），7 例患者接受非隧道式灵活内镜方法（平均年龄 64.4 岁，85.7%为男性）。MIMI 组的平均 ZD 大小为 2.8cm，非隧道式灵活内镜组为 1.9cm（p=0.03）。MIMI 组 17/19（89.5%）患者和非隧道式灵活内镜组 7/7（100%）患者获得临床成功（p=0.101）。两组的吞咽困难评分均有所改善，但 MIMI 组的差异具有统计学意义（p≤0.001）。MIMI 组有 2/17（11.7%）患者和非隧道式灵活内镜组有 3/7（42.9%）患者出现复发（p=0.096）。MIMI 组发生 4 例并发症，包括 1 例小 ZD 伴环状软骨后狭窄患者发生咽穿孔，需行开放手术修复。MIMI 组的中位随访时间为 290[142;465]天，非隧道式灵活内镜组为 1056[258;1206]天（p=0.094）。
MIMI 是治疗 ZD 的一种技术可行且有效的方法。对于存在环状软骨后狭窄和小 ZD 的患者应谨慎操作，因为这可能会增加穿孔的风险。需要进行更大规模的、具有长期随访的研究，以确定与非隧道式灵活内镜方法相比，MIMI 是否会降低症状复发的风险。
