Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ.
Methodist Health System, Dallas, TX.
J Clin Gastroenterol. 2022 Mar 1;56(3):224-227. doi: 10.1097/MCG.0000000000001579.
Endoscopic management of Zenker diverticuli (ZD) has traditionally been via septotomy technique. The recent development of tunneling technique has shown to be both efficacious and safe. The aim of this study is to evaluate the tunneling technique using per oral endoscopic myotomy (Z-POEM) versus septotomy.
Patients who underwent endoscopic management of ZD either by Z-POEM or septotomy from March 2017 until November 2020 from 9 international academic centers were included. Demographics, clinical data preprocedure and postprocedure, procedure time, adverse events, and hospital length of stay were analyzed.
A total of 101 patients (mean age 74.9 y old, 55.4% male) were included: septotomy (n=49), Z-POEM (n=52). Preprocedure Functional Oral Intake Scale score and Eckardt score was 5.3 and 5.4 for the septotomy group and 5.9 and 5.15 for the Z-POEM group. Technical success was achieved in 98% of the Z-POEM group and 100% of the septotomy group. Clinical success was achieved in 84% and 92% in the septotomy versus Z-POEM groups. Adverse events occurred in 30.6% (n=15) in septotomy group versus 9.6% (n=5) in the Z-POEM group (P=0.017). Reintervention for ongoing symptoms occurred in 7 patients in the septotomy group and 3 patients in the Z-POEM group. Mean hospital length of stay was shorter for the Z-POEM group, at 1.5 versus 1.9 days.
A tunneling technique via the Z-POEM procedure is an efficacious and safe endoscopic treatment for ZD. Z-POEM is a safer procedure with a statistically significant reduction in adverse events compared with traditional septotomy technique.
Zenker 憩室（ZD）的内镜治疗传统上采用隔切开术技术。最近发展的隧道技术已被证明是有效且安全的。本研究旨在评估经口内镜肌切开术（Z-POEM）与隔切开术治疗 ZD 的隧道技术。
从 2017 年 3 月至 2020 年 11 月，来自 9 个国际学术中心的患者接受了 ZD 的内镜治疗，包括 Z-POEM 或隔切开术。分析了人口统计学、术前和术后临床数据、手术时间、不良事件和住院时间。
共纳入 101 例患者（平均年龄 74.9 岁，55.4%为男性）：隔切开术（n=49），Z-POEM（n=52）。隔切开术组术前功能性口服摄入量表评分和 Eckardt 评分分别为 5.3 和 5.4，Z-POEM 组分别为 5.9 和 5.15。Z-POEM 组技术成功率为 98%，隔切开术组为 100%。临床成功率分别为 84%和 92%，隔切开术组优于 Z-POEM 组。隔切开术组发生不良事件 30.6%（n=15），Z-POEM 组为 9.6%（n=5）（P=0.017）。隔切开术组中有 7 例患者因持续症状需要再次介入，Z-POEM 组有 3 例。Z-POEM 组的平均住院时间较短，为 1.5 天，而隔切开术组为 1.9 天。
经 Z-POEM 隧道技术是治疗 ZD 的一种有效且安全的内镜治疗方法。与传统的隔切开术技术相比，Z-POEM 是一种更安全的手术，不良事件发生率有统计学显著降低。
