Department of Otolaryngology-Head and Neck Surgery, University of California, Davis, Sacramento, California, U.S.A.
Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A.
Laryngoscope. 2023 Nov;133(11):3057-3060. doi: 10.1002/lary.30726. Epub 2023 May 2.
Endoscopic Zenker's diverticulotomy (EZD) is typically performed via stapling (endoscopic staple diverticulotomy; ESD) or CO2 laser (endoscopic laser diverticulotomy; ELD). Conflicting reports exist on which approach provides optimal outcomes. This investigation compared objective fluoroscopic data between ESD and ELD.
A retrospective review of all patients undergoing primary EZD at a tertiary center between January 1, 2014 and January 10, 2022 was performed. Patients undergoing ESD and ELD were matched by preoperative diverticulum size. Primary outcome measures were postoperative diverticulum size and change in diverticulum size from pre- to postoperative swallowing fluoroscopy. Secondary outcome measures were the Eating Assessment Tool (EAT-10) score, penetration aspiration scale (PAS), pharyngeal constriction ratio (PCR), and pharyngoesophageal segment opening (PESo).
Thirteen matched pairs with complete fluoroscopic data were identified. The mean (±SD) age of the cohort was 74.0 (±8.5) years. There were no age or gender differences between groups (p > 0.05). The mean pre-operative ZD size was 1.98 (±0.69) cm for ESD and 1.97 (±0.72) cm for ELD; the mean postoperative size was 0.84 (±0.62) cm for ESD and 0.34 (±0.27) cm for ELD (p < 0.05). Mean diverticulum size improved by 1.14 (±0.59) cm after ESD and 1.62 (±0.59) cm after ELD (p < 0.05). There were no significant differences in postoperative EAT-10, PAS, PCR, or PESo between groups.
The data suggest that endoscopic laser Zenker's diverticulotomy results in a greater improvement in diverticulum size than endoscopic staple diverticulotomy. The data did not suggest a difference in postoperative dysphagia symptom scores or other objective fluoroscopic parameters between staple and laser diverticulotomy.
Level 3 Laryngoscope, 133:3057-3060, 2023.
经内镜 Zenker 憩室切开术（EZD）通常通过吻合器（内镜吻合器憩室切开术；ESD）或二氧化碳激光（内镜激光憩室切开术；ELD）进行。哪种方法能提供最佳结果存在相互矛盾的报告。本研究比较了 ESD 和 ELD 之间的客观荧光透视数据。
对 2014 年 1 月 1 日至 2022 年 1 月 10 日在三级中心接受原发性 EZD 的所有患者进行了回顾性分析。通过术前憩室大小对接受 ESD 和 ELD 的患者进行匹配。主要观察指标为术后憩室大小和吞咽荧光透视术前后憩室大小的变化。次要观察指标为饮食评估工具（EAT-10）评分、渗透抽吸量表（PAS）、咽缩肌比（PCR）和咽食管段开口（PESo）。
确定了 13 对具有完整荧光透视数据的匹配对。队列的平均（±SD）年龄为 74.0（±8.5）岁。两组间年龄和性别无差异（p>0.05）。ESD 的平均术前 ZD 大小为 1.98（±0.69）cm，ELD 为 1.97（±0.72）cm；ESD 的平均术后大小为 0.84（±0.62）cm，ELD 为 0.34（±0.27）cm（p<0.05）。ESD 后憩室大小平均改善 1.14（±0.59）cm，ELD 后改善 1.62（±0.59）cm（p<0.05）。两组间术后 EAT-10、PAS、PCR 或 PESo 无显著差异。
数据表明，内镜激光 Zenker 憩室切开术可使憩室大小改善程度大于内镜吻合器憩室切开术。数据并未表明吻合器和激光憩室切开术之间术后吞咽困难症状评分或其他客观荧光透视参数存在差异。
Laryngoscope 133：3057-3060，2023 年。
