Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India.
Department of Pharmacology, PGIMER, Chandigarh, India.
Dysphagia. 2022 Feb;37(1):84-92. doi: 10.1007/s00455-021-10252-0. Epub 2021 Feb 3.
With the advent of the technique of sub-mucosal tunnelling, peroral endoscopic myotomy (POEM) has been used for the treatment of esophageal diverticulum, which otherwise is a recurring problem with conventional flexible endoscopic treatment due to incompleteness of septotomy. This study reports our experience of the use of diverticular POEM (D-POEM) technique in the management of large esophageal diverticulum. This is a retrospective study of prospectively maintained database including all consecutive patients with symptomatic esophageal diverticulum presenting at a tertiary care academic center. D-POEM was performed using the technique of submucosal tunnelling and septotomy. Besides baseline parameters, technical success, clinical success, size of diverticula, procedure time, complications and symptom recurrence on follow up were noted. A total of five patients (4 males; median age 72) were included with an average Charlson comorbidity index of 3.2 ± 0.8. Of them, three had Zenker's while two had epiphrenic diverticulum. The median symptom duration was 12 months with a mean diverticulum size of 68.8 ± 1.9 mm. The mean procedure time was 64.80 ± 12.6 min. with a mean septotomy/myotomy length of 79.44 ± 12.2 mm. Minor adverse events were noted intra-procedure in two cases. Clinical success achieved in all cases with a significant mean dysphagia score reduction from 2.20 to 0.20 post procedure (p = 0.011). On a median follow up of 280 days (range 98-330), none had recurrence of symptoms. Our data highlighted that complete septotomy by D-POEM technique can be achieved for the management of large esophageal diverticulum and is safe and effective.
随着黏膜下隧道技术的出现，经口内镜肌切开术（POEM）已被用于治疗食管憩室，否则由于不完全的隔切开术，常规的软性内镜治疗会导致憩室反复发作。本研究报告了我们使用憩室 POEM（D-POEM）技术治疗大食管憩室的经验。这是一项回顾性研究，对在三级学术中心就诊的有症状食管憩室的连续患者进行了前瞻性数据库维护。D-POEM 使用黏膜下隧道和隔切开术进行。除了基线参数外，还记录了技术成功率、临床成功率、憩室大小、手术时间、并发症以及随访时的症状复发情况。共纳入 5 名患者（4 名男性；中位年龄 72 岁），平均 Charlson 合并症指数为 3.2±0.8。其中 3 例为Zenker 憩室，2 例为膈上憩室。中位症状持续时间为 12 个月，平均憩室大小为 68.8±1.9mm。平均手术时间为 64.80±12.6min，平均隔切开术/肌切开术长度为 79.44±12.2mm。术中注意到 2 例出现轻微不良事件。所有患者均获得临床成功，术后平均吞咽困难评分从 2.20 降至 0.20（p=0.011）。在中位随访 280 天（范围 98-330）期间，无一例症状复发。我们的数据表明，通过 D-POEM 技术可以实现完全的隔切开术，用于治疗大食管憩室，并且安全有效。
