Digestive Diseases & Surgical Institute, Cleveland Clinic London, London, UK.
Department of Gastroenterology, University College London Hospital, Euston Road, London, NW1 2BU, UK.
Surg Endosc. 2024 Oct;38(10):5842-5850. doi: 10.1007/s00464-024-11164-4. Epub 2024 Aug 19.
Minimally invasive endoscopic options are safe and effective alternatives to surgery for the treatment of symptomatic Zenker's diverticulum (ZD). However, there is no consensus on the gold-standard approach. We compared the safety and efficacy of Zenker's peroral endoscopic myotomy (Z-POEM), flexible diverticulotomy (FD), and rigid diverticulotomy (RD) for the management of ZD.
Patients undergoing treatment for ZD at three UK tertiary referral centres were identified and analysed between 2013 and 2023. Patient demographics, procedural details, clinical success, and 30-day adverse events (AE) were recorded. The primary outcomes were technical and clinical success defined as a fall in Dakkak and Bennett dysphagia score to ≤ 1 without re-intervention.
There was no difference in baseline characteristics amongst 126 patients undergoing intervention (50 RD, 31 FD, 45 Z-POEM). Technical success for RD, FD, and Z-POEM was 80%, 100%, and 100%, respectively (p < 0.001). Over a mean follow-up of 11.0 months (95% CI 8.2-13.9), clinical success amongst those treated was 85.3% (RD), 74.1% (FD), and 83.7% (Z-POEM; p = 0.48) with recurrence in 17.2% (RD), 20.0% (FD), and 8.3% (Z-POEM; p = 0.50). AEs were equivalent between groups (p = 0.98). During this time, 11 patients underwent surgical myotomy with low clinical success (36.4%) and high morbidity.
Endoscopic options for the treatment of ZD show equivalent rates of success, but failed RD often led to open myotomy with worse outcomes. Flexible endoscopic modalities are both safe and highly effective treatments that may be considered first-line in experienced centres and should be offered before surgery.
对于有症状的Zenker 憩室（ZD）的治疗，微创内镜选择是手术的安全有效替代方法。然而，对于金标准方法尚无共识。我们比较了 Zenker 经口内镜肌切开术（Z-POEM）、软性憩室切开术（FD）和硬性憩室切开术（RD）治疗 ZD 的安全性和疗效。
在 2013 年至 2023 年间，我们在英国的三个三级转诊中心确定并分析了接受 ZD 治疗的患者。记录了患者的人口统计学、程序细节、临床成功和 30 天不良事件（AE）。主要结果是技术和临床成功，定义为 Dakkak 和 Bennett 吞咽困难评分降至≤1 而无需再次干预。
在接受干预的 126 名患者中，基线特征没有差异（50 名 RD、31 名 FD、45 名 Z-POEM）。RD、FD 和 Z-POEM 的技术成功率分别为 80%、100%和 100%（p<0.001）。在平均 11.0 个月（95%CI 8.2-13.9）的随访中，治疗后的临床成功率分别为 85.3%（RD）、74.1%（FD）和 83.7%（Z-POEM；p=0.48），复发率分别为 17.2%（RD）、20.0%（FD）和 8.3%（Z-POEM；p=0.50）。各组之间的 AE 相当（p=0.98）。在此期间，11 名患者接受了手术肌切开术，临床成功率低（36.4%）且发病率高。
ZD 的治疗内镜选择成功率相当，但 RD 治疗失败常导致开放性肌切开术，结果更差。软性内镜治疗方法既安全又非常有效，在经验丰富的中心可以考虑作为一线治疗方法，应在手术前提供。
