Gastroenterology Department, Endoscopy Unit, Humanitas Clinical and Research Center -IRCCS.
Department of Biomedical Sciences, Humanitas University, Rozzano, Italy.
Eur J Gastroenterol Hepatol. 2021 Dec 1;33(1S Suppl 1):e78-e83. doi: 10.1097/MEG.0000000000002318.
In the last decade, flexible endoscopic septotomy has been reported as a well-tolerated and effective treatment for Zenker's diverticulum. More recently, novel endoscopic submucosal tunneling techniques, namely Zenker-PerOral Endoscopic Myotomy (Z-POEM) and PerOral Endoscopic Septotomy (POES) have been proposed to obtain complete muscular septum exposure and deeper myotomy. The aim of this study is to provide a systematic review with a meta-analysis of the first experiences of third space approaches for Zenker's diverticulum. Electronic databases (Medline, Scopus, EMBASE) were searched up to October 2020. Studies including patients with symptomatic Zenker's diverticulum who underwent endoscopic treatment by submucosal tunneling technique were eligible. Procedural, clinical and safety outcomes were assessed by pooling data with a random-effect model to obtain a proportion with a 95% confidence interval. Nine retrospective studies were eligible for inclusion (196 patients). Five studies were performed in the USA, two in Europe and two in Asia. Endoscopic treatment was feasible in 96.9% (I2 = 0%) of patients. The mean procedure duration was 36.4 ± 14.3 minutes. Clinical success was achieved after 93.4% (I2 = 0%) of procedures. The overall adverse events rate was 4.9% (I2 = 0%). No differences between the two approaches (Z-POEM vs POES) have been shown in terms of both efficacy and safety. Submucosal tunneling techniques appear to be feasible for symptomatic Zenker's diverticulum, with promising results in terms of efficacy and safety outcomes.
在过去的十年中，弹性内镜隔切开术已被报道为Zenker 憩室的一种耐受良好且有效的治疗方法。最近，新的内镜黏膜下隧道技术，即 Zenker 经口内镜肌切开术（Z-POEM）和经口内镜隔切开术（POES）已被提出，以获得完全的肌隔暴露和更深的肌切开。本研究的目的是对 Zenker 憩室的第三间隙方法的首次经验进行系统评价和荟萃分析。电子数据库（Medline、Scopus、EMBASE）检索至 2020 年 10 月。纳入接受黏膜下隧道技术内镜治疗的有症状 Zenker 憩室患者的研究。通过随机效应模型汇总数据评估手术、临床和安全性结果，以获得 95%置信区间的比例。9 项回顾性研究符合纳入标准（196 例患者）。其中 5 项研究在美国进行，2 项在欧洲进行，2 项在亚洲进行。内镜治疗在 96.9%（I2=0%）的患者中是可行的。平均手术时间为 36.4±14.3 分钟。93.4%（I2=0%）的手术获得临床成功。总不良事件发生率为 4.9%（I2=0%）。两种方法（Z-POEM 与 POES）在疗效和安全性方面均无差异。黏膜下隧道技术似乎对有症状的 Zenker 憩室是可行的，在疗效和安全性方面有很好的结果。
