Ren Lihua, Ye Hui, Zhu Ye, Xie Weihua, Liang Yan, Liu Yang, Dong Jingwu, Chen Weixu, Chen Xinfu, Wang Bin, Pan Liang, Shi Ruihua
Department of Gastroenterology, Zhongda Hospital, School of Medicine, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, Jiangsu Province, People's Republic of China.
Department of Quality Management, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China.
Surg Endosc. 2024 Jan;38(1):253-259. doi: 10.1007/s00464-023-10471-6. Epub 2023 Nov 20.
To evaluate the medium- and long-term outcomes of diverticular peroral endoscopic myotomy (D-POEM) for symptomatic oesophageal diverticulum.
Consecutive patients with symptomatic oesophageal diverticulum who underwent D-POEM from 1st May 2016 to 1st April 2020 in 6 centres were extracted and researched. Symptoms assessed by the modified Eckardt score were registered pre- and post-D-POEM at 1, 6, 12, 24 and 36 months.
A total of 34 patients with Zenker's diverticulum (ZD, n = 12), mid-oesophageal diverticulum (MED, n = 12), and epiphrenic diverticulum (ED, n = 10) were included. Complete septotomy was achieved in a mean of 39.15 min, with 100% technical success. No severe intraoperative or postoperative complications were observed. Five patients exhibited subcutaneous emphysema, while 1 had mucosal injury. The mean Eckardt score was 8.59 preoperatively and 2.56 at 1 month, 2.09 at 6 months, 2.21 at 12 months, 2.15 at 24 months, and 2.21 at 36 months postoperatively. The total clinical success rates at 1, 6, 12, 24 and 36 months postoperatively were 97.1%, 97.1%, 94.1%, 91.2%, and 88.2%, respectively. With a median follow-up of 47.2 months, four patients suffered symptom relapse, with a total clinical success rate of 88.2%. A long disease duration, a high Eckardt score, and coexistence of achalasia were identified as risk factors for symptomatic recurrence by multivariable Cox analysis.
D-POEM is an effective and durable treatment for patients with symptomatic oesophageal diverticulum.
评估经口内镜下憩室肌切开术（D-POEM）治疗有症状食管憩室的中长期疗效。
选取2016年5月1日至2020年4月1日期间在6个中心接受D-POEM治疗的有症状食管憩室的连续患者进行研究。采用改良埃卡德特评分评估症状，在D-POEM术前以及术后1、6、12、24和36个月进行记录。
共纳入34例患者，其中Zenker憩室（ZD，n = 12）、食管中段憩室（MED，n = 12）和膈上憩室（ED，n = 10）。平均39.15分钟完成完整的肌切开术，技术成功率达100%。未观察到严重的术中或术后并发症。5例患者出现皮下气肿，1例有黏膜损伤。术前平均埃卡德特评分为8.59分，术后1个月为2.56分，6个月为2.09分，12个月为2.21分，24个月为2.15分，36个月为2.21分。术后1、6、12、24和36个月的总临床成功率分别为97.1%、97.1%、94.1%、91.2%和88.2%。中位随访47.2个月，4例患者症状复发，总临床成功率为88.2%。多变量Cox分析确定病程长、埃卡德特评分高和并存贲门失弛缓症是症状复发的危险因素。
D-POEM是治疗有症状食管憩室患者的一种有效且持久的治疗方法。
