Mavrogenis Georgios, Zachou Maria, Tsevgas Ioannis, Markoglou Konstantinos, Zachariadis Dimitrios, Spanomanoli Anna, Chatzis Marinos, Bazerbachi Fateh
Unit of Hybrid Interventional Endoscopy, Department of Gastroenterology, Mediterraneo Hospital, Athens, Greece (Georgios Mavrogenis, Maria Zachou, Ioannis Tsevgas, Konstantinos Markoglou, Dimitrios Zachariadis).
Department of Anesthesiology, Mediterraneo Hospital, Athens, Greece (Anna Spanomanoli, Marinos Chatzis).
Ann Gastroenterol. 2024 Sep-Oct;37(5):509-513. doi: 10.20524/aog.2024.0902. Epub 2024 Jul 12.
Peroral endoscopic myotomy (Z-POEM) is an effective treatment for Zenker's diverticulum (ZD), but procedural time and safety vary based on technique. Modified Z-POEM approaches incorporating fewer submucosal tunnels may offer advantages.
In this retrospective, single-center study, we compared outcomes among 20 patients with ZD undergoing standard Z-POEM (2 tunnels), single-tunnel Z-POEM (ST Z-POEM), or tunnel-free Z-POEM (TF Z-POEM). All procedures included mucosotomy over the septum and deep extension of myotomy into the esophagus (2 cm). Primary endpoints were procedural time, clinical success, and adverse events.
Patients had a mean age of 67.3±12.2 years, and 70% presented with respiratory symptoms. Mean procedure times were 45 min (standard Z-POEM), 33 min (ST Z-POEM), and 30 min (TF Z-POEM), with a statistically significant difference between the standard and TF Z-POEM groups (P=0.014). Technical success was 100%, and the mean hospital stay was 1.3±1.3 days. One adverse event (5%) occurred. Clinical success, defined as improvement in dysphagia score (3 to 0.05, P<0.001) and resolution of respiratory symptoms, was achieved in all patients.
In this study, modified Z-POEM techniques utilizing single-tunnel or tunnel-free approaches, combined with over-the-septum mucosotomy and deep esophageal myotomy (2 cm), demonstrated feasibility, safety and a significantly shorter procedural time compared to standard Z-POEM. These findings suggest potential benefits for ZD treatment, warranting further investigation in larger prospective studies.
经口内镜下肌切开术（Z-POEM）是治疗Zenker憩室（ZD）的有效方法，但手术时间和安全性因技术而异。采用较少黏膜下隧道的改良Z-POEM方法可能具有优势。
在这项回顾性单中心研究中，我们比较了20例接受标准Z-POEM（2条隧道）、单隧道Z-POEM（ST Z-POEM）或无隧道Z-POEM（TF Z-POEM）的ZD患者的治疗结果。所有手术均包括在隔膜上进行黏膜切开术，并将肌切开术深入食管（2厘米）。主要终点为手术时间、临床成功率和不良事件。
患者的平均年龄为67.3±12.2岁，70%的患者出现呼吸道症状。平均手术时间分别为45分钟（标准Z-POEM）、33分钟（ST Z-POEM）和30分钟（TF Z-POEM），标准组和TF Z-POEM组之间存在统计学显著差异（P=0.014）。技术成功率为100%，平均住院时间为1.3±1.3天。发生了1例不良事件（5%）。所有患者均实现了临床成功，定义为吞咽困难评分改善（从3分降至0.05分，P<0.001）以及呼吸道症状消失。
在本研究中，采用单隧道或无隧道方法的改良Z-POEM技术，结合隔膜上黏膜切开术和深入食管肌切开术（2厘米），与标准Z-POEM相比，显示出可行性、安全性且手术时间显著缩短。这些发现提示了对ZD治疗的潜在益处，值得在更大规模的前瞻性研究中进一步探究。
