经口内镜肌切开术治疗大型Zenker 憩室。

Zenker's peroral endoscopic myotomy for management of large Zenker's diverticulum.

机构信息

Johns Hopkins Medicine, Baltimore, Maryland, United States.

National Medical Center Century XXI, Mexico City, Mexico.

出版信息

Endoscopy. 2023 Jun;55(6):501-507. doi: 10.1055/a-2025-0715. Epub 2023 Feb 24.

DOI:10.1055/a-2025-0715

PMID:36827992

Abstract

BACKGROUND

Zenker's diverticulum peroral endoscopic myotomy (zPOEM) is a minimally invasive treatment strategy for Zenker's diverticulum, with excellent results for management of small-to-moderate Zenker's diverticulum. We evaluated its use in the management of large Zenker's diverticulum.

METHODS

This was a retrospective multicenter cohort study across 11 international centers including adult patients with large Zenker's diverticulum ≥ 40 mm treated by zPOEM between March 2017 and March 2022. The primary outcome was clinical success (dysphagia score ≤ 1 without need for further intervention). Secondary outcomes included technical success (complete myotomy as intended), adverse events (AEs), and rate of recurrence.

RESULTS

83 patients (male 62.7 %, mean age 72.6 [SD 11.5] years) underwent zPOEM for treatment of large Zenker's diverticulum (median size 50 mm, interquartile range [IQR] 41-55 mm, range 40-80 mm). The zPOEM procedure was technically successful in 82 patients (98.8 %), with a mean procedure time of 48.7 (SD 23.2) minutes. Clinical success was achieved in 71 patients (85.5 %). Median (IQR) symptom scores improved significantly from baseline for dysphagia (2 2 3 vs. 0 [0-2]; < 0.001), regurgitation (3 2 3 4 vs. 0 [0-0]; < 0.001), and respiratory symptoms (2 [0-3] vs. 0 [0-0]; < 0.001). Among patients achieving clinical success, only one recurrence (1.4 %) was recorded during a median follow-up of 12.2 months (IQR 3-28). Post-procedure AEs, all mild to moderate, occurred in four patients (4.8 %).

CONCLUSION

This study demonstrated safe and effective use of zPOEM in the management of large Zenker's diverticulum.

摘要

背景

Zenker 憩室经口内镜肌切开术（zPOEM）是一种治疗 Zenker 憩室的微创治疗策略，对于管理小至中等大小的 Zenker 憩室效果极佳。我们评估了其在治疗大型 Zenker 憩室中的应用。

方法

这是一项回顾性多中心队列研究，涉及 11 个国际中心的成年患者，这些患者在 2017 年 3 月至 2022 年 3 月期间接受了 zPOEM 治疗，Zenker 憩室≥40mm。主要结果是临床成功（吞咽困难评分≤1 且无需进一步干预）。次要结果包括技术成功（预期完成肌切开术）、不良事件（AE）和复发率。

结果

83 例（男性 62.7%，平均年龄 72.6[11.5]岁）接受 zPOEM 治疗大型 Zenker 憩室（中位数大小 50mm，四分位距[IQR]41-55mm，范围 40-80mm）。82 例（98.8%）患者的 zPOEM 手术技术成功，平均手术时间为 48.7（23.2）分钟。71 例（85.5%）患者达到临床成功。吞咽困难（223 与 0[0-2]；<0.001）、反流（3234 与 0[0-0]；<0.001）和呼吸症状（2[0-3]与 0[0-0]；<0.001）的症状评分均从基线显著改善。在达到临床成功的患者中，中位随访 12.2 个月（IQR 3-28）期间仅记录到 1 例（1.4%）复发。4 例（4.8%）患者发生术后轻度至中度 AE。