Budnicka Aleksandra, Januszewicz Władysław, Białek Andrzej B, Spychalski Michal, Reguła Jaroslaw, Kaminski Michal F
Department of Gastroenterological Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland.
Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, 02-781 Warsaw, Poland.
J Clin Med. 2021 Jan 7;10(2):187. doi: 10.3390/jcm10020187.
Peroral endoscopic myotomy (POEM) is an emerging technique in the treatment of Zenker's diverticulum (ZD). This study aimed to analyze the feasibility of Zenker's POEM (Z-POEM) in a multicenter setting and assess its performance using a validated Kothari-Haber Scoring System newly developed for symptom measurement in ZD.
This was a multicenter retrospective study involving three Polish tertiary referral endoscopic units. The data of consecutive patients with symptomatic ZD treated with Z-POEM in Poland between May 2019 and August 2020 were retrieved and analyzed. Primary outcome measures were technical success and clinical success rate (<3 points in Kothari-Haber Score at 2-3 months follow-up). Secondary outcome measures included procedures' duration, length of hospital stay, and adverse events.
22 patients with symptomatic ZD were included. The mean age was 67.6 (±10.7) years, and 14 (63.6%) were male. All but two patients were treatment naïve. The average size of the ZD was 30 mm (IQR, 24-40 mm). Technical success was achieved in all patients (100%), whereas clinical success was 90.9%. The average Kothari-Haber Score was 6.35 before treatment and has dropped to 0.65 after the treatment ( < 0.0001). The mean procedure time was 48.8 (±19.3) minutes, and the median length of hospital stay was 2 days (IQR, 2-3). Three patients (13.6%) had post-procedural emphysema, of which two were mild and self-resolving (9.1%), and one was moderate (4.5%) and complicated with laryngeal edema and prolonged intubation.
This feasibility study suggests that Z-POEM is a highly effective and safe treatment for ZD, particularly among treatment-naïve patients. Comparative studies with other treatment modalities over longer follow-up are warranted.
经口内镜下肌切开术（POEM）是治疗Zenker憩室（ZD）的一项新兴技术。本研究旨在分析多中心环境下Zenker经口内镜下肌切开术（Z-POEM）的可行性，并使用新开发的用于ZD症状测量的经过验证的Kothari-Haber评分系统评估其疗效。
这是一项多中心回顾性研究，涉及波兰的三个三级转诊内镜科室。检索并分析了2019年5月至2020年8月期间在波兰接受Z-POEM治疗的有症状ZD连续患者的数据。主要结局指标为技术成功率和临床成功率（随访2-3个月时Kothari-Haber评分<3分）。次要结局指标包括手术持续时间、住院时间和不良事件。
纳入了22例有症状ZD患者。平均年龄为67.6（±10.7）岁，14例（63.6%）为男性。除两名患者外，所有患者均未接受过治疗。ZD的平均大小为30mm（四分位间距，24-40mm）。所有患者均取得技术成功（100%），而临床成功率为90.9%。治疗前平均Kothari-Haber评分为6.35，治疗后降至0.65（<0.0001）。平均手术时间为48.8（±19.3）分钟，中位住院时间为2天（四分位间距，2-3天）。3例患者（13.6%）术后出现气肿，其中2例为轻度且可自行缓解（9.1%），1例为中度（4.5%）并伴有喉水肿和插管时间延长。
这项可行性研究表明，Z-POEM是治疗ZD的一种高效且安全的方法，尤其是在未接受过治疗的患者中。有必要进行更长时间随访的与其他治疗方式的比较研究。
