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Lee WG, Evans LL, Chen CS, Fuchs JR, Zamora IJ, Bruzoni M, Harrison MR, Muensterer OJ. Lessons Learned From the First-In-Human Compassionate Use of Connect-EA™ in Ten Patients With Esophageal Atresia. J Pediatr Surg 2024; 59:437-444. [PMID: 37838619 DOI: 10.1016/j.jpedsurg.2023.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 10/16/2023]
Abstract
INTRODUCTION Delayed primary repair of esophageal atresia in patients with high-risk physiologic and anatomic comorbidities remains a daunting challenge with an increased risk for peri-operative morbidity and mortality via conventional repair. The Connect-EA device facilitates the endoscopic creation of a secure esophageal anastomosis. This follow-up study reports our long-term outcomes with the novel esophageal magnetic compression anastomosis (EMCA) Connect-EA device for EA repair, as well as lessons learned from the ten first-in-human cases. We propose an algorithm to maximize the advantages of the device for EA repair. METHODS Under compassionate use approval, from June 2019 to December 2022, ten patients with prohibitive surgical or medical risk factors underwent attempted EMCA with this device. All patients underwent prior gastrostomy, tracheoesophageal fistula ligation (if necessary), and demonstrated pouch apposition prior to EMCA. RESULTS Successful device deployment and EMCA formation were achieved in nine patients (90%). Mean time to anastomosis formation was 8 days (range 5-14) and the device was retrieved endoscopically in five (56%) cases. At median follow-up of 22 months (range 4-45), seven patients (78%) are tolerating oral nutrition. Balloon dilations (median 4, range 1-11) were performed either prophylactically for radiographic asymptomatic anastomotic narrowing (n = 7, 78%) or to treat clinically-significant anastomotic narrowing (n = 2, 22%) with no ongoing dilations at 3-month follow up post-repair. CONCLUSION EMCA with the Connect-EA device is a safe and feasible minimally-invasive alterative for EA repair in high-risk surgical patients. Promising post-operative outcomes warrant further Phase I investigation. LEVEL OF EVIDENCE IV, Case series of novel operative technique without comparison group.
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Affiliation(s)
- William G Lee
- Department of Pediatric Surgery, University of California San Francisco, 550 16th Street Box 0570, San Francisco, CA 94143, USA
| | - Lauren L Evans
- Department of Pediatric Surgery, University of California San Francisco, 550 16th Street Box 0570, San Francisco, CA 94143, USA
| | - Caressa S Chen
- Department of Pediatric Surgery, University of California San Francisco, 550 16th Street Box 0570, San Francisco, CA 94143, USA
| | - Julie R Fuchs
- Division of Pediatric Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA 94304, USA
| | - Irving J Zamora
- Department of Pediatric Surgery, Monroe Carell Jr Children's Hospital at Vanderbilt, 2200 Children's Way 7th Floor, Nashville, TN 37232, USA
| | - Matias Bruzoni
- Division of Pediatric Surgery, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA 94304, USA
| | - Michael R Harrison
- Department of Pediatric Surgery, University of California San Francisco, 550 16th Street Box 0570, San Francisco, CA 94143, USA
| | - Oliver J Muensterer
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, LMU Munich, Lindwurmstrasse 4, 80337, Munich, Germany.
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Gaber A, Fadloon I, Shehab H. Diverticular peroral endoscopic myotomy: management of a complex epiphrenic diverticulum. Endoscopy 2023; 55:E918-E919. [PMID: 37442179 PMCID: PMC10344611 DOI: 10.1055/a-2107-2287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Affiliation(s)
- Abdelazeez Gaber
- Integrated Clinical and Research Center for Intestinal Disorders (ICRID), Gastroenterology Division, Endemic Medicine Department, Cairo University, Cairo, Egypt
| | - Ismail Fadloon
- Integrated Clinical and Research Center for Intestinal Disorders (ICRID), Gastroenterology Division, Endemic Medicine Department, Cairo University, Cairo, Egypt
| | - Hany Shehab
- Integrated Clinical and Research Center for Intestinal Disorders (ICRID), Gastroenterology Division, Endemic Medicine Department, Cairo University, Cairo, Egypt
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Boyanov N, Andonov V, Shtereva K, Madzharova K, Stoynov N, Dimitrova D, Yankov I. Initial experience in target peroral endoscopic submucosal myotomy combined with septotomy for epiphrenic diverticulum. Folia Med (Plovdiv) 2023; 65:490-494. [PMID: 38351827 DOI: 10.3897/folmed.65.e83893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/18/2022] [Indexed: 02/16/2024] Open
Abstract
The epiphrenic esophageal diverticulum is a rare non-malignant condition that is commonly associated with motility disorders. It would normally be treated surgically, but with the advancement of endoscopy techniques, peroral endoscopic myotomy with septotomy (D-POEM) has shown its benefits in coping with the symptoms. We present a case of a 71-year-old woman with increasing symptoms of dysphagia, weight loss and imaging data showing a large epiphrenic diverticulum. We treated her using peroral endoscopic myotomy combined with septotomy of the diverticular septum. The procedure showed excellent results with reducing the amount of contrast materials retained in it, improving the quality of life of the patient, and increasing her weight. There were minimal adverse events and no perforations or severe adverse effects occurred. D-POEM is a new and rapidly evolving procedure that is proving to be a safe and effective method of treating epiphrenic esophageal diverticulum.
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Affiliation(s)
| | | | | | | | | | | | - Ivan Yankov
- Medical University of Plovdiv, Plovdiv, Bulgaria
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Daza Castro EM, Fuentes CF, Córdoba Guzmán AC, Aponte D, Rocha JN, González C, Sabbagh LC. Multimodal Endoscopic Management of Esophageal Perforations as a Complication of Peroral Endoscopic Myotomy for a Zenker's Diverticulum. ACG Case Rep J 2023; 10:e01059. [PMID: 37312755 PMCID: PMC10259639 DOI: 10.14309/crj.0000000000001059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/24/2023] [Indexed: 06/15/2023] Open
Abstract
Zenker's diverticulum develops because of a weakness in Killian's triangle, leading to a mucosal and submucosal herniation. Its treatment has evolved from morbid surgical interventions to safer endoscopic techniques such as peroral endoscopic myotomy (Z-POEM). Despite being a safe technique, Z-POEM is not free of complications such as perforations, bleeding, pneumoperitoneum, and pneumothorax, for which new endoscopic techniques have been developed. We present the case of a 53-year-old man taken to a Z-POEM who postoperatively presented dehiscence of the mucosotomy and a mediastinal collection, managed with a vacuum-assisted endoscopic closure device.
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Affiliation(s)
| | - Carlos Fernando Fuentes
- Department of Gastroenterology, Sanitas Foundation University, Colombia University Clinic, Keralty Group, Bogotá, Colombia
| | | | - Diego Aponte
- Department of Gastroenterology, Sanitas Foundation University, Colombia University Clinic, Keralty Group, Bogotá, Colombia
- Department of Gastroenterology, Sanitas Foundation University, Reina Sofía Clinic, Colsanitas Clinic, Keralty Group, Bogotá, Colombia
| | - José Nicolás Rocha
- Department of Gastroenterology, Sanitas Foundation University, Colombia University Clinic, Keralty Group, Bogotá, Colombia
| | - Carlos González
- Department of Gastroenterology, Sanitas Foundation University, Colombia University Clinic, Keralty Group, Bogotá, Colombia
- Department of Gastroenterology, Sanitas Foundation University, Reina Sofía Clinic, Colsanitas Clinic, Keralty Group, Bogotá, Colombia
| | - Luis Carlos Sabbagh
- Department of Gastroenterology, Sanitas Foundation University, Colombia University Clinic, Keralty Group, Bogotá, Colombia
- Department of Gastroenterology, Sanitas Foundation University, Reina Sofía Clinic, Colsanitas Clinic, Keralty Group, Bogotá, Colombia
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Albéniz E, Marra-López Valenciano C, Estremera-Arévalo F, Sánchez-Yagüe A, Montori S, Rodríguez de Santiago E. POEM from A to Z: current perspectives. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2023. [PMID: 37073708 DOI: 10.17235/reed.2023.9602/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
The "third space endoscopy" or also called "submucosal endoscopy" is a reality we can transfer to our patients since 2010. Various modifications of the submucosal tunneling technique allow access to the submucosa or deeper layers of the gastrointestinal tract. In addition to peroral endoscopic myotomy for the treatment of achalasia, also called esophageal POEM, other variants have emerged that make it possible to treat different esophageal motility disorders, esophageal diverticula, subepithelial tumors of various locations, gastroparesis, reconnection of complete esophageal strictures or even thanks to exceptional endoscopists, pediatric disorders such as Hirschsprung's disease. Although some technical aspects are yet to be standardized, these procedures are becoming widespread worldwide and will likely become the standard treatment of these pathologies soon.
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Affiliation(s)
- Eduardo Albéniz
- Endoscopy Unit. Gastroenterology, Hospital Universitario de Navarra (HUN). Navarrabiomed. UPNA, IdiSNA, España
| | | | | | | | - Sheyla Montori
- Gastrointestinal Endoscopy Research Unit, Hospital Universitario de Navarra (HUN). Navarrabiomed. UPNA, IdiSNA, Spain
| | - Enrique Rodríguez de Santiago
- Gastroenterology and Hepatology , Hospital Universitario Ramón y Cajal. Universidad de Alcalá. IRYCIS. CIBERehd. ISCIII, Spain
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Di Tommaso GR, de Castro GL, Júnior ECC, Printes TRM, da Silva Neto RA, da Silva Júnior RA. Large epiphrenic esophageal diverticulum in symptomatic patient managed laparoscopically: Case report and review of literature. Int J Surg Case Rep 2023; 106:108060. [PMID: 37080153 DOI: 10.1016/j.ijscr.2023.108060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/19/2023] [Accepted: 03/21/2023] [Indexed: 04/01/2023] Open
Abstract
INTRODUCTION Diverticular disease most common site in digestive tract is large intestine, but can also appears in small intestine and esophagus. Esophageal diverticula are divided according to injured portion (pharyngeal, middle or epiphrenic). CASE PRESENTATION We present a case of large epiphrenic diverticulum in a 71-year-old woman with mild gastrointestinal symptoms managed laparoscopically with diverticulectomy and fundoplication. DISCUSSION Epiphrenic esophageal diverticulum is rare, originated from unknown increase of intraesophageal pressure. Diagnosis usually occurs with imaging and endoscopic investigation and surgical treatment is indicated for symptomatic patients. CONCLUSION High suspicion and proper analysis are fundamental for diagnosis and treatment definition, which may include outpatient follow-up or surgery.
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Affiliation(s)
- Gabriel Reis Di Tommaso
- General Surgery service and Resident of Digestive Tract Surgery at Getúlio Vargas University Hospital (HUGV), 4 Apurinã Avenue, Praça 14 de Janeiro, Manaus, Amazonas 69020-170, Brazil.
| | - Gustavo Lopes de Castro
- Faculty of Medicine of the Federal University of Amazonas (UFAM), 1053 Afonso Pena St, Praça 14 de Janeiro, Manaus, Amazonas 69020-160, Brazil
| | - Eneas Carlos Cavalcante Júnior
- General Surgery service and Resident of Digestive Tract Surgery at Getúlio Vargas University Hospital (HUGV), 4 Apurinã Avenue, Praça 14 de Janeiro, Manaus, Amazonas 69020-170, Brazil
| | - Thaís Regina Moreira Printes
- General Surgery service and Resident of Digestive Tract Surgery at Getúlio Vargas University Hospital (HUGV), 4 Apurinã Avenue, Praça 14 de Janeiro, Manaus, Amazonas 69020-170, Brazil
| | - Rubem Alves da Silva Neto
- General Surgery service and Digestive Tract surgery service at Getúlio Vargas University Hospital (HUGV), Preceptor in Digestive Tract Surgery Medical Residence Program, 4 Apurinã Avenue, Praça 14 de Janeiro, Manaus, Amazonas 69020-170, Brazil
| | - Rubem Alves da Silva Júnior
- General Surgery service and Digestive Tract surgery service at Getúlio Vargas University Hospital (HUGV), Technical manager and Coordinator of Digestive Tract Surgery Medical Residence Program, 4 Apurinã Avenue, Praça 14 de Janeiro, Manaus, Amazonas 69020-170, Brazil
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Constantin A, Constantinoiu S, Achim F, Socea B, Costea DO, Predescu D. Esophageal diverticula: from diagnosis to therapeutic management-narrative review. J Thorac Dis 2023; 15:759-779. [PMID: 36910058 PMCID: PMC9992562 DOI: 10.21037/jtd-22-861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 12/12/2022] [Indexed: 02/04/2023]
Abstract
Background and Objective Esophageal diverticulum (ED) is a relatively rare condition, characterized by high etio- and pathophysiological versatility, with an uncommon clinical impact, consequently requiring a complete and complex diagnostic evaluation, so that the therapeutic decision is "appropriate" to a specific case. The aim of the paper is, therefore, a reassessment of the diagnostic possibilities underlying the establishment of the therapeutic protocol and the available therapeutic resources, making a review of the literature, and a non-statistical retrospective analysis of cases hospitalized and operated in a tertiary center. Methods Thus, classical investigations (upper digestive endoscopy, barium swallow) need to be correlated with complex, manometric, and imaging evaluations with direct implications in therapeutic management. Moreover, in the absence of a precise etiology, the operative indication needs to be established sparingly, with the imposition of the identification and interception of the pathophysiological mechanisms through the therapeutic gesture. Key Content and Findings The identification of the pathophysiological mechanisms is mandatory for the management of diverticular disease, the result obtained-restoring swallowing and comfort/good quality of life in the postoperative period-is directly related to the chosen therapeutic procedure. In addition, management appears to be a difficult goal in the context of the low incidence of ED but also of the results that emphasize important differences in the reports in the medical literature. Although ED is a benign condition, surgical techniques are demanding, impacted by significant morbidity and mortality. The causes of these results are multiple: possible localizations anywhere in the esophagus, diverticulum size/volume from a few millimeters to an impressive one, over 10-12 cm, metabolic impact in direct relation to the alteration swallowing, numerous diverticular complications but, perhaps most importantly, alteration of the quality of the diverticular wall by inflammatory phenomena, with an impact on the quality of the suture. Conclusions The accumulation of cases in a tertiary profile center, with volume/hospital, respectively volume/surgeon + gastroenterologist could be a solution in improving the results. One consequence would be the identification of alternative solutions to open surgical techniques, a series of minimally invasive or endoscopic variants can refine these results.
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Affiliation(s)
- Adrian Constantin
- General and Esophageal Clinic, Sf. Maria Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Silviu Constantinoiu
- General and Esophageal Clinic, Sf. Maria Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Florin Achim
- General and Esophageal Clinic, Sf. Maria Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Bogdan Socea
- Department of Surgery, Sf. Pantelimon Emergency Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Daniel Ovidiu Costea
- Department II of Surgery, Emergency Hospital, Ovidius University of Medicine, Constanta, Romania
| | - Dragos Predescu
- General and Esophageal Clinic, Sf. Maria Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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8
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Noh JH, Jung HY. Role of Endoscopy in Motility Disorders of Upper Gastrointestinal Tract. J Neurogastroenterol Motil 2023; 29:7-19. [PMID: 36606432 PMCID: PMC9837547 DOI: 10.5056/jnm22170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/19/2022] [Indexed: 01/07/2023] Open
Abstract
Gastrointestinal motility disorders have a wide range of symptoms and affect patients' quality of life. With the advancement of endoscopy, the diagnostic and therapeutic roles of endoscopy in motility disorders is becoming more significant. Endoscopy is necessary to rule out possible organic diseases in patients with suspected motility disorders and provide significant clues for their diagnosis. Moreover, interventional endoscopy may be a primary or alternative treatment option for selected patients with motility disorders, and it is becoming a promising field as new therapeutic applications are developed and utilized for various motility disorders. This review may provide suitable indications for the use of endoscopy in diagnosing and treating motility disorders of the upper gastrointestinal tract.
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Affiliation(s)
- Jin Hee Noh
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea,Correspondence: Hwoon-Yong Jung, MD, PhD, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea, Tel: +82-2-3010-3197, Fax: +82-2-476-0824, E-mail:
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9
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Boutron C, Rebibo L, Duboc H, Antonopulos C, Calabrese D, Coffin B, Msika S. Thoracoscopic approach as surgical management of esophageal epiphrenic diverticulum. J Visc Surg 2023:S1878-7886(23)00005-X. [PMID: 36710123 DOI: 10.1016/j.jviscsurg.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Management of diverticulum of the lower esophagus or epiphrenic diverticulum can be performed using the abdominal or thoracic approach. In some cases, the thoracic approach is preferred, but few studies have described thoracoscopic resection. The objective of the present study was to investigate the thoracoscopic approach for management of epiphrenic esophageal diverticulum. MATERIAL AND METHODS From 2008 to 2018, all patients undergoing surgery for epiphrenic esophageal diverticulum by the thoracoscopic approach were included in this single-center, retrospective, observational study. Data on diverticulum, surgery and follow-up were assessed. RESULTS During the study period, 14 patients underwent surgery. Two patients had two diverticula. The mean location of the superior edge of the diverticulum was 7cm (2-14cm) above the gastro-esophageal junction. The mean size of the diverticulum was 39 millimeters (20-60). Thoracoscopic approach was used in all patients. No conversion to thoracotomy was required. Mean operative time was 168min (120-240). No postoperative mortality occurred. The overall complication rate was 40% (6 complications out of 15 resections), with three major complications including leaks (n=2) and a case of bronchoesophageal fistula (n=1). Median length of hospital stay was 12 days (8-40). At a mean postoperative follow-up of 20.7 months (5-71), 85% of patients had complete disappearance of preoperative symptoms without recurrence of the diverticulum on the barium swallow study test. CONCLUSION Thoracoscopic approach as management of epiphrenic diverticulum is feasible, with acceptable short-term morbidity. The thoracoscopic approach is also effective in resolving preoperative symptoms.
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Affiliation(s)
- C Boutron
- Digestive, esogastric and bariatric surgery department, Bichat Claude Bernard hospital, Paris, France; Sorbonne university, 75013 Paris, France
| | - L Rebibo
- Digestive, esogastric and bariatric surgery department, Bichat Claude Bernard hospital, Paris, France; Department of digestive and oncologic surgery, européen Georges Pompidou hospital, Assistance publique-Hôpitaux de Paris, Paris, France; Inserm UMR 1149, Paris university, 75018 Paris, France
| | - H Duboc
- Inserm UMR 1149, Paris university, 75018 Paris, France; Department of gastroenterology, Louis Mourier university hospital, Colombes, France
| | - C Antonopulos
- Digestive, esogastric and bariatric surgery department, Bichat Claude Bernard hospital, Paris, France
| | - D Calabrese
- Digestive, esogastric and bariatric surgery department, Bichat Claude Bernard hospital, Paris, France; Inserm UMR 1149, Paris university, 75018 Paris, France
| | - B Coffin
- Inserm UMR 1149, Paris university, 75018 Paris, France; Department of gastroenterology, Louis Mourier university hospital, Colombes, France
| | - S Msika
- Digestive, esogastric and bariatric surgery department, Bichat Claude Bernard hospital, Paris, France; Inserm UMR 1149, Paris university, 75018 Paris, France.
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Shimamura Y, Fujiyoshi Y, Fujiyoshi MRA, Inoue H. Evolving field of third-space endoscopy: Derivatives of peroral endoscopic myotomy. Dig Endosc 2023; 35:162-172. [PMID: 35816387 DOI: 10.1111/den.14400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 01/24/2023]
Abstract
Third-space endoscopy, also known as submucosal endoscopy, allows for a wide range of therapeutic interventions within the submucosal layer and even into the muscular or subserosal layers of the gastrointestinal lumen. The technical development of peroral endoscopic myotomy (POEM) for achalasia has revolutionized the field of therapeutic endoscopy and the method has been continuously refined and modified. Although POEM has been applied to treat primary achalasia, it shows a favorable clinical response in other esophageal motility disorders and as a salvage treatment after previously failed intervention. Gastroesophageal reflux after POEM has drawn considerable attention and there have been major advancements in its prevention and management. POEM has led to advantageous derivatives such as peroral endoscopic tumor resection or submucosal tunneling endoscopic resection for resection of subepithelial lesions, Zenker POEM for hypopharyngeal diverticula, diverticular POEM for epiphrenic esophageal diverticula, and gastric POEM for refractory gastroparesis. These techniques have a similar concept, which constitutes submucosal tunneling with a mucosal flap valve and secure mucosal incision closure. The submucosal tunneling technique is widely accepted and continues to evolve. This study aimed to review in detail the indications, outcomes, and technical variations in POEM and explore several emerging submucosal tunneling procedures. This review will benefit future studies by providing a summary of recent developments in this field.
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Affiliation(s)
- Yuto Shimamura
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Yusuke Fujiyoshi
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | | | - Haruhiro Inoue
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
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Singhartinger F, Gantschnigg A, Mühlbacher I, Wagner A, Koch O, Emmanuel K, Holzinger J. Novel technique of flexible endoscopic therapy of Zenker’s diverticulum using a pulsed Holmium laser—a retrospective single-center analysis. Surg Endosc 2022; 37:2706-2711. [PMID: 36451040 PMCID: PMC10082092 DOI: 10.1007/s00464-022-09775-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/22/2022] [Indexed: 12/03/2022]
Abstract
Abstract
Background
In recent years, flexible endoscopic therapy of Zenker’s diverticulum seems to become the standard approach. The aim of this study was to assess the safety, efficacy and short-term outcome of flexible endoscopic diverticulotomy of Zenker’s diverticulum with a pulsed Holmium laser (PHL).
Patients and methods
All patients treated with endoscopic laser-diverticulotomy using a PHL between February 2013 and November 2021 at the University Hospital Salzburg were extracted from our prospectively maintained endoscopic database. Demographic data, size of Zenker’s diverticulum, procedure duration, complications, short-term outcome and rate of recurrence were evaluated.
Results
In the study period, 45 procedures in 36 patients were performed. Mean depth of the Zenker diverticulum was 21 mm (10–60 mm), mean procedure time was 31 min (15–60 min), intraprocedural adverse events occurred in 2 out of 45 patients (5%) which were both managed endoscopically, post-procedural stenosis occurred in 1 patient (2%). In the follow-up examinations (mean follow-up after 6.4 months), 27 out of 36 patients (75%) were symptom-free, 6 patients (17%) reported an improvement of dysphagia. 3 patients (9%) suffered from persistent dysphagia. After initial symptom relief, a recurrent diverticulum occurred in 5 patients. Endoscopic re-intervention with PHL was done in these cases.
Conclusions
Flexible endoscopic treatment of primary and recurrent Zenker’s diverticulum using a PHL is a promising, safe and effective treatment with, in our opinion, technical advantages in comparison to the CO2 laser. Further controlled prospective trials are needed.
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Affiliation(s)
- Franz Singhartinger
- Department for Surgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.
| | - Antonia Gantschnigg
- Department for Surgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Iris Mühlbacher
- Department for Surgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Andrej Wagner
- Department for Internal Medicine I, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Oliver Koch
- Department for Surgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Klaus Emmanuel
- Department for Surgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Josef Holzinger
- Department for Surgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
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Facciorusso A, Ramai D, Ichkhanian Y, Yadlapati R, Annese V, Wani S, Khashab MA. Peroral Endoscopic Myotomy for the Treatment of Esophageal Diverticula: A Systematic Review and Meta-analysis. J Clin Gastroenterol 2022; 56:853-862. [PMID: 34608024 PMCID: PMC8977395 DOI: 10.1097/mcg.0000000000001622] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 09/04/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND There is limited evidence on the efficacy of peroral endoscopic myotomy (POEM) in patients with esophageal diverticula. AIMS This meta-analysis aimed to assess the efficacy and safety profile of POEM in patients with Zenker (ZD) and epiphrenic diverticula. METHODS With a literature search through August 2020, we identified 12 studies (300 patients) assessing POEM in patients with esophageal diverticula. The primary outcome was treatment success. Results were expressed as pooled rates and 95% confidence intervals. RESULTS Pooled rate of technical success was 95.9% (93.4%-98.3%) in ZD patients and 95.1% (88.8%-100%) in patients with epiphrenic diverticula. Pooled rate of treatment success was similar for ZD (90.6%, 87.1%-94.1%) and epiphrenic diverticula (94.2%, 87.3%-100%). Rates of treatment success were maintained at 1 year (90%, 86.4%-97.4%) and 2 years (89.6%, 82.2%-96.9%) in ZD patients. Pooled rate of symptom recurrence was 2.6% (0.9%-4.4%) in ZD patients and 0% in patients with epiphrenic diverticula. Pooled rates of adverse events and severe adverse events were 10.6% (4.6%-16.6%) and 3.5% (0%-7.4%) in ZD and 8.4% (0%-16.8%) and 8.4% (0%-16.8%) in epiphrenic diverticula, respectively. CONCLUSION POEM represents an effective and safe therapy for the treatment of esophageal diverticula.
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Affiliation(s)
| | - Daryl Ramai
- Department of Medicine, The Brooklyn Hospital Center, Brooklyn, New York
| | - Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, John Hopkins University Hospital, Baltimore
| | - Rena Yadlapati
- Division of Gastroenterology, University of California San Diego, La Jolla, California
| | - Vito Annese
- Valiant Clinic & American Hospital, Dubai, United Arab Emirates
| | - Sachin Wani
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, U.S.A
| | - Mouen A. Khashab
- Division of Gastroenterology and Hepatology, John Hopkins University Hospital, Baltimore
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13
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Quan YS, Yao J, Wang LS. Peroral endoscopic myotomy for multiple esophageal diverticula. Endoscopy 2022; 54:E771-E772. [PMID: 35395688 PMCID: PMC9735242 DOI: 10.1055/a-1795-7215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Yong-Sheng Quan
- Department of Gastroenterology, Second Clinical Medical College of Jinan University, Shenzhen People’s Hospital, Shenzhen, Guangdong Province, China
| | - Jun Yao
- Department of Gastroenterology, Second Clinical Medical College of Jinan University, Shenzhen People’s Hospital, Shenzhen, Guangdong Province, China
| | - Li-Sheng Wang
- Department of Gastroenterology, Second Clinical Medical College of Jinan University, Shenzhen People’s Hospital, Shenzhen, Guangdong Province, China
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14
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Al Ghamdi SS, Farha J, Moran RA, Pioche M, Moll F, Yang DJ, Hernández Mondragón OV, Ujiki M, Wong H, Tantau A, Sedarat A, Fejleh MP, Chang K, Lee DP, Nieto JM, Andrawes S, Ginsberg GG, Saumoy M, Bapaye A, Dashatwar P, Aghaie Meybodi M, Lopez AC, Sanaei O, Yousaf MN, Jovani M, Ichkhanian Y, Brewer Gutierrez OI, Kumbhari V, O'Rourke AK, Lentsch EJ, Elmunzer BJ, Khashab MA. Zenker's peroral endoscopic myotomy, or flexible or rigid septotomy for Zenker's diverticulum: a multicenter retrospective comparison. Endoscopy 2022; 54:345-351. [PMID: 34198355 DOI: 10.1055/a-1518-7223] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Treatment of Zenker's diverticulum has evolved from open surgery to endoscopic techniques, including flexible and rigid endoscopic septotomy, and more recently, peroral endoscopic myotomy (Z-POEM). This study compared the effectiveness of flexible and rigid endoscopic septotomy with that of Z-POEM. METHODS Consecutive patients who underwent endoscopic septotomy (flexible/rigid) or Z-POEM for Zenker's diverticulum between 1/2016 and 9/2019 were included. Primary outcomes were clinical success (decrease in Dakkak and Bennett dysphagia score to ≤ 1), clinical failure, and clinical recurrence. Secondary outcomes included technical success and rate/severity of adverse events. RESULTS 245 patients (110 females, mean age 72.63 years, standard deviation [SD] 12.37 years) from 12 centers were included. Z-POEM was the most common management modality (n = 119), followed by flexible (n = 86) and rigid (n = 40) endoscopic septotomy. Clinical success was 92.7 % for Z-POEM, 89.2 % for rigid septotomy, and 86.7 % for flexible septotomy (P = 0.26). Symptoms recurred in 24 patients (15 Z-POEM during a mean follow-up of 282.04 [SD 300.48] days, 6 flexible, 3 rigid [P = 0.47]). Adverse events occurred in 30.0 % rigid septotomy patients, 16.8 % Z-POEM patients, and 2.3 % flexible septotomy patients (P < 0.05). CONCLUSIONS There was no difference in outcomes between the three treatment approaches for symptomatic Zenker's diverticulum. Rigid endoscopic septotomy was associated with the highest rate of complications, while flexible endoscopic septotomy appeared to be the safest. Recurrence following Z-POEM was similar to flexible and rigid endoscopic septotomy. Prospective studies with long-term follow-up are required.
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Affiliation(s)
- Sarah S Al Ghamdi
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Jad Farha
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Robert A Moran
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Mathieu Pioche
- Gastroenterology, Edouard Herriot Hospital, Lyon, France
| | - Frédéric Moll
- Gastroenterology, Edouard Herriot Hospital, Lyon, France
| | - Dennis J Yang
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, United States
| | | | - Michael Ujiki
- Division of Minimally Invasive Surgery, NorthShore's Grainger Center for Simulation and Innovation, Evanston, Illinois, United States
| | - Harry Wong
- Division of Minimally Invasive Surgery, NorthShore's Grainger Center for Simulation and Innovation, Evanston, Illinois, United States
| | - Alina Tantau
- Department of Gastroenterology, the 4th Medical Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alireza Sedarat
- Ronald Reagan UCLA Medical Center, UCLA Medical Center, Los Angeles, California, United States
| | - M Phillip Fejleh
- Ronald Reagan UCLA Medical Center, UCLA Medical Center, Los Angeles, California, United States
| | - Kenneth Chang
- H.H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Irvine, California, United States
| | - David P Lee
- H.H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Irvine, California, United States
| | - Jose M Nieto
- Borland Groover Clinic Advance Therapeutic Endoscopy Center and Baptist Medical Center, Jacksonville, Florida, United States
| | - Sherif Andrawes
- Division of Gastroenterology and Hepatology, Staten Island University Hospital - Northwell Health, Staten Island, New York, United States
| | - Gregory G Ginsberg
- Endoscopic Services, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Monica Saumoy
- Endoscopic Services, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Amol Bapaye
- Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Parag Dashatwar
- Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Mohamad Aghaie Meybodi
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Ariana C Lopez
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Omid Sanaei
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | | | - Manol Jovani
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Olaya I Brewer Gutierrez
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Ashli K O'Rourke
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Eric J Lentsch
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, United States
| | - B Joseph Elmunzer
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
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15
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Kahaleh M, Mahpour NY, Tyberg A, Bareket R, Shahid HM, Sarkar A, Abdelqader A, Gjeorgjievski M, Marino D, Kats D, Gaidhane M, Greenberg I, Lee DP, Bushe B, Eke C, Sun H, Kedia P, Méndez ALM, Lambroza A, Barret M, Hallit R, Eleftheriadis NP, Nieto J, Oleas R, Robles-Medranda C, Bapaye A. Per Oral Endoscopic Myotomy for Zenker's Diverticulum: A Novel and Superior Technique Compared With Septotomy? J Clin Gastroenterol 2022; 56:224-227. [PMID: 34183618 DOI: 10.1097/mcg.0000000000001579] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/26/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Endoscopic management of Zenker diverticuli (ZD) has traditionally been via septotomy technique. The recent development of tunneling technique has shown to be both efficacious and safe. The aim of this study is to evaluate the tunneling technique using per oral endoscopic myotomy (Z-POEM) versus septotomy. METHODS Patients who underwent endoscopic management of ZD either by Z-POEM or septotomy from March 2017 until November 2020 from 9 international academic centers were included. Demographics, clinical data preprocedure and postprocedure, procedure time, adverse events, and hospital length of stay were analyzed. RESULTS A total of 101 patients (mean age 74.9 y old, 55.4% male) were included: septotomy (n=49), Z-POEM (n=52). Preprocedure Functional Oral Intake Scale score and Eckardt score was 5.3 and 5.4 for the septotomy group and 5.9 and 5.15 for the Z-POEM group. Technical success was achieved in 98% of the Z-POEM group and 100% of the septotomy group. Clinical success was achieved in 84% and 92% in the septotomy versus Z-POEM groups. Adverse events occurred in 30.6% (n=15) in septotomy group versus 9.6% (n=5) in the Z-POEM group (P=0.017). Reintervention for ongoing symptoms occurred in 7 patients in the septotomy group and 3 patients in the Z-POEM group. Mean hospital length of stay was shorter for the Z-POEM group, at 1.5 versus 1.9 days. CONCLUSIONS A tunneling technique via the Z-POEM procedure is an efficacious and safe endoscopic treatment for ZD. Z-POEM is a safer procedure with a statistically significant reduction in adverse events compared with traditional septotomy technique.
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Affiliation(s)
- Michel Kahaleh
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Noah Y Mahpour
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Amy Tyberg
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Romy Bareket
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Haroon M Shahid
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Avik Sarkar
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Abdelhai Abdelqader
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Mihajlo Gjeorgjievski
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Daniel Marino
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Daniel Kats
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Monica Gaidhane
- Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | | | | | | | | | | | | | | | | | | | | | | | | | - Roberto Oleas
- Gastroenterology and Endoscopy Division, Ecuadorian Institute of Digestive Diseases (IECED), Guayaquil, Ecuador
| | - Carlos Robles-Medranda
- Gastroenterology and Endoscopy Division, Ecuadorian Institute of Digestive Diseases (IECED), Guayaquil, Ecuador
| | - Amol Bapaye
- Deenanath Mangeshkar Hospital and Research Center, Pune, India
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16
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Treatment of Achalasia and Epiphrenic Diverticulum. World J Surg 2022; 46:1547-1553. [PMID: 35142875 DOI: 10.1007/s00268-022-06476-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Epiphrenic diverticulum (ED) is a pulsion pseudodiverticulum found in the distal 10 cm of the esophagus. Motility disorders are present in the majority of patients with ED explaining the pathophysiology of this rare disease. Achalasia is the most common underlying disorder. We present a review on the diagnosis and management of ED in the setting of achalasia. METHODS Literature review. RESULTS Symptoms are most related to the underlying motility disorder. The diagnostic workup should always include an upper digestive endoscopy and a barium esophagogram. Esophageal manometry identifies the motility disorder in most patients. Therapeutic options include laparoscopic, thoracoscopic and endoscopic procedures. While a myotomy must always be performed, diverticulectomy is not always necessary. CONCLUSIONS Epiphrenic diverticulum is a rare condition whose pathophysiology involves an underlying motility disorder-achalasia in most cases. Symptoms usually include dysphagia, regurgitation, heartburn, and respiratory complaints and correlate with the motility disorder rather than the diverticulum per se. Upper digestive endoscopy and barium esophagogram are needed for the diagnosis-manometry may add useful information but is not imperative for the treatment. Laparoscopic Heller myotomy with a partial fundoplication is the procedure of choice, with satisfactory symptom relief and several advantages over the thoracic approach. Diverticulectomy may be performed in selected patients. Peroral endoscopic myotomy (POEM) are novel techniques, effective and minimally invasive that can be an option for patients unfit for surgery.
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17
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Peroral endoscopic myotomy treatment for symptomatic esophageal diverticulum: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2022; 34:128-136. [PMID: 33252417 DOI: 10.1097/meg.0000000000002001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Peroral endoscopic myotomy (POEM) is a rapidly evolving technique for the treatment of esophageal diverticulum. The aim of this study was to perform a systematic review and meta-analysis of the literature focusing on POEM for symptomatic esophageal diverticula, including an in-depth evaluation of its efficacy, safety, and limitations. A comprehensive literature search was completed to identify articles that examined the efficacy and safety of POEM for esophageal diverticula. Heterogeneity among studies was assessed using the I2 statistic. Meta-regression and sensitivity analyses were performed to explore the sources of heterogeneity and assess potentially important covariates influencing the main outcomes. Primary endpoints such as rates of success, adverse events, and recurrences were evaluated. P values of ≤0.05 were considered statistically significant. Nine studies with a total of 153 patients were enrolled. Pooled technical success, clinical success, adverse events, and recurrence rates were 99% [95% confidence interval (CI), 97-100%; I2 = 0%), 94% (95% CI, 89-97%; I2 = 24%), 2% (95% CI, 0-6%, I2 = 0%), and 0% (95% CI, 0-1%; I2 = 0%), respectively. The pooled perforation rate was 6% (95% CI, 1-11%; I2 = 0%). Meta-regression analysis indicated that esophageal diverticula types and motility disorders were not associated with the clinical success rate (P > 0.05). POEM is a feasible, safe, and effective treatment for symptomatic esophageal diverticula, with low adverse events and recurrence rates.
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18
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Oh SJ, Runge TM, Khashab MA, Sloan JA. Cut and Tied: Esophageal Dysmotility and Epiphrenic Diverticulum Treated with Peroral Endoscopic Myotomy (POEM) and Septotomy. Dig Dis Sci 2022; 67:446-451. [PMID: 33763786 DOI: 10.1007/s10620-021-06914-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2021] [Indexed: 12/09/2022]
Affiliation(s)
- Sun Jung Oh
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, USA.
| | - Thomas M Runge
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, USA.,Division of Gastroenterology, Hepatology and Nutrition, Ohio State University Wexner Medical Center, Columbus, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Joshua A Sloan
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, USA.,Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, USA
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19
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Yang L, Yang SS. Ultrasonographic diagnosis and characteristic analysis of achalasia cardia in a pediatric patient. Asian J Surg 2021; 45:725-726. [PMID: 34930654 DOI: 10.1016/j.asjsur.2021.09.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 08/27/2021] [Accepted: 09/06/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Lin Yang
- Department of Ultrasound, The Central Hospital of Wuhan, Wuhan, 430000, Hubei, China
| | - Shun-Shi Yang
- Department of Ultrasound, The Central Hospital of Wuhan, Wuhan, 430000, Hubei, China.
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20
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Sommer R, Machado Grossi JV, Grossi Harada GR, Seabra MK, Cavazzola LT, Seabra AP. Treatment of Giant Esophageal Epiphrenic Diverticulum Using Robotic-Assisted Surgery. CRSLS : MIS CASE REPORTS FROM SLS 2021; 9:CRSLS.2021.00068. [PMID: 36016814 PMCID: PMC9387394 DOI: 10.4293/crsls.2021.00068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Epiphrenic diverticulum is a rare condition associated with esophageal motor disorder, and it is often asymptomatic, with a well-established surgical indication. The present study aims to report a case of a giant epiphrenic diverticulum in a 68-year-old male patient who, due to the symptoms, opted for surgical treatment using the daVinci® system. Robotic surgery consisting of esophageal diverticulectomy with cardiomyotomy was performed. The patient had an excellent recovery with an abbreviated hospitalization, return to food, and satisfactory routine activity.
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Affiliation(s)
- Renato Sommer
- Department of Surgery, Moinhos de Vento Hospital, Porto Alegre, Brazil
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21
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Peroral Endoscopic Myotomy Is a Safe and Feasible Option in Management of Esophageal Diverticula: Systematic Review and Meta-Analysis. Dig Dis Sci 2021; 66:3242-3249. [PMID: 33123940 DOI: 10.1007/s10620-020-06678-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/13/2020] [Indexed: 12/12/2022]
Abstract
Esophageal diverticula can cause significant symptoms and affect the quality of life. There has been recent interest in the use of peroral endoscopic myotomy in the management of esophageal diverticula (D-POEM). In this meta-analysis, we have evaluated the efficacy and safety of D-POEM in the management of esophageal diverticula. Several databases were reviewed from inception to 6/19/2020 to identify the studies evaluating the feasibility, efficacy and safety of D-POEM in the management of esophageal diverticula. Our outcomes of interest were technical success, adverse events and difference in mean pre- and post-procedure symptom score. We performed subgroup analysis including patients with Zenker's diverticulum who underwent POEM (Z-POEM). Pooled rates with 95% confidence intervals (CI) for all outcomes were calculated using random effect model. We calculated standard mean difference (SMD) with 95% CI to compare mean pre- and post-procedure symptom score. We included 7 studies with 233 patients. For D-POEM, pooled rates (95% CI) for technical success and adverse events were 95% (91%, 97%) and 6% (3%, 10%) respectively. For Z-POEM, pooled rates (95% CI) for technical success and adverse events were 95% (90%, 97%) and 6% (3%, 10%) respectively. Mean post-procedure symptom score for all patients who underwent D-POEM was significantly lower compared to mean pre-procedure symptom score, SMD (95% CI) 2.17 (1.51, 2.83). This meta-analysis demonstrated that D-POEM is a safe and feasible option for patients with symptomatic esophageal diverticula.
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22
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Sereke SG, Bongomin F, Muyinda Z. Zenker's diverticulum in an 85-year-old Ugandan man. BMC Gastroenterol 2021; 21:338. [PMID: 34461856 PMCID: PMC8406572 DOI: 10.1186/s12876-021-01914-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/20/2021] [Indexed: 12/04/2022] Open
Abstract
Background Zenker’s diverticulum (ZD) is an uncommon disorder due to an outpouching of tissue through the Killian triangle that is thought to be caused by dysfunction of the cricopharyngeal muscle. Case presentation An 85-year-old male patient presented with odynophagia and dysphagia of initially solid food followed by fluids that was associated with a significant weight loss over a one-year period. Barium swallow videofluoroscopy demonstrated a posterior outpouching of proximal esophagus that was 2 cm from the epiglottis. With the diagnosis of medium sized ZD, the patient underwent endoscopy guided diverticulotomy. Six months after the procedure, he was asymptomatic and had gained weight. Conclusions Dysphagia and weight loss raises a clinical suspicion for a malignancy. Barium swallow examination is an inexpensive method for the diagnosis of ZD.
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Affiliation(s)
- Senai Goitom Sereke
- Department of Radiology and Radiotherapy, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Felix Bongomin
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Zeridah Muyinda
- Department of Radiology, Mulago National Referral Hospital, Kampala, Uganda
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23
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Lhuillery E, Etchepareborde S. Surgical management of a cervical esophageal diverticulum in and long-term outcome for a five-month-old cat. J Am Vet Med Assoc 2021; 259:396-400. [PMID: 34337966 DOI: 10.2460/javma.259.4.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION A 5-month-old domestic shorthair cat was presented for recurrent regurgitation and hypersalivation after eating, which had been evident since adoption 2 months earlier. CLINICAL FINDINGS Physical examination was unremarkable. Plain thoracic radiography, positive contrast esophagography, endoscopy, CT, electromyography, and blood analysis were performed. A caudal cervical esophageal diverticulum, likely congenital, was diagnosed. TREATMENT AND OUTCOME A diverticulectomy was performed with a surgical stapler while an endoscope was in the esophageal lumen. No intra- or postoperative complications were reported. Postoperative and short-term outcomes were excellent, with resolution of clinical signs and no endoscopic esophageal abnormality 3 months after surgery. The cat remained without clinical signs 8 months after surgery. CLINICAL RELEVANCE An esophageal diverticulum in a cat is rare. The cat of this report had a good outcome following surgical management of a cervical esophageal diverticulum. Surgery is worth considering for similarly affected cats, but additional cases are required to confirm the benefit of surgery versus conservative management.
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24
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Zhang X, Jiao H, Liu X. Bronchoesophageal fistula secondary to esophageal diverticulum in an adult: a case report and literature review. J Int Med Res 2021; 49:300060521992234. [PMID: 33596687 PMCID: PMC7897816 DOI: 10.1177/0300060521992234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Esophageal diverticulum with secondary bronchoesophageal fistula is a rare clinical entity that manifests as respiratory infections, coughing during eating or drinking, hemoptysis, and sometimes fatal complications. In the present study, we describe a case of bronchoesophageal fistula emanating from esophageal diverticulum in a 45-year-old man who presented with bronchiectasis. We summarize the characteristics of this rare condition based on a review of the relevant literature.
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Affiliation(s)
- Xiaolin Zhang
- Department of Geriatrics, 26447Peking University First Hospital, Beijing, China
| | - Hongmei Jiao
- Department of Geriatrics, 26447Peking University First Hospital, Beijing, China
| | - Xinmin Liu
- Department of Geriatrics, 26447Peking University First Hospital, Beijing, China
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25
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Zeng X, Bai S, Zhang Y, Ye L, Yuan X, Hu B. Peroral endoscopic myotomy for the treatment of esophageal diverticulum: an experience in China. Surg Endosc 2021; 35:1990-1996. [PMID: 32347387 DOI: 10.1007/s00464-020-07593-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 04/22/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND With the development of minimally invasive endoscopic approaches for the esophagus in recent years, peroral endoscopic myotomy (POEM) in the treatment of esophageal diverticulum has been described recently in some reports due to its successful outcomes. The aim of this study is to report our experience with the use of diverticular POEM (D-POEM) technique in the management of esophageal diverticulum. METHODS This retrospective study included consecutive patients with symptomatic esophageal diverticulum who visited our endoscopy center between April 2014 and January 2019. D-POEM was performed based on the principles of submucosal endoscopy. A new symptomatic scoring system was introduced to evaluate the severity of diverticular symptoms. RESULTS A total of 10 patients with esophageal diverticulum (Zenker's 2, mid-esophagus 5, and epiphrenic 3) were included. The overall technical success rate of D-POEM was 100%, with a mean procedure time of 38.9 ± 20.5 (range 16-70) min. No serious complications occurred. Clinical improvement was achieved in 90% (9/10) of patients. The symptomatic score was significantly decreased from 2.5 (IQR 2.00-3.25) to 1.0 (IQR 0-1.25) (P = 0.007) during a median follow-up period of 11.0 (IQR 10.25-17.25) months. CONCLUSION These findings suggested complete septotomy by D-POEM. Our preliminary data and experience put forwarded D-POEM as a safe and effective technique for esophageal diverticulum.
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Affiliation(s)
- Xianhui Zeng
- Department of Gastroenterology, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Wuhou District, Chengdu, China
| | - Shuai Bai
- Department of Gastroenterology, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Wuhou District, Chengdu, China
| | - Yuhang Zhang
- Department of Gastroenterology, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Wuhou District, Chengdu, China
| | - Liansong Ye
- Department of Gastroenterology, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Wuhou District, Chengdu, China
| | - Xianglei Yuan
- Department of Gastroenterology, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Wuhou District, Chengdu, China
| | - Bing Hu
- Department of Gastroenterology, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Wuhou District, Chengdu, China.
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26
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Chillarge G, O'Neill R, Safranek P. Mid-oesophageal traction diverticulum in a patient with systemic lupus erythematosus. BMJ Case Rep 2021; 14:14/4/e238529. [PMID: 33827867 PMCID: PMC8030673 DOI: 10.1136/bcr-2020-238529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
In this report, a case of a large mid-oesophageal traction diverticulum in a 66-year-old woman with systemic lupus erythematosus has been presented. She was initially managed conservatively with active surveillance for 6 years. When her symptoms progressed, she had repeat endoscopy and CT scan which showed an increase in size of the diverticulum to 6 cm in diameter. Her dysphagia had progressively deteriorated and she was only managing a liquid diet. She, therefore, proceeded to resection of the diverticulum by right thoracotomy and stapled diverticulectomy. She made an excellent postoperative recovery and at last review, 5 months after the operation, she was back at work, had put on weight, and was tolerating a normal diet.
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Affiliation(s)
- Gauri Chillarge
- General Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Robert O'Neill
- Cambridge Oesophagogastric Centre, Addenbrooke's Hospital, Cambridge, UK
| | - Peter Safranek
- General Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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27
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Frieling T. [Diverticula in the gastrointestinal tract]. Internist (Berl) 2021; 62:277-287. [PMID: 33560449 DOI: 10.1007/s00108-021-00942-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Abstract
The prevalence of diverticula varies depending on the location within the gastrointestinal tract. Diverticula of the esophagus, stomach and small intestine are rare, more frequent are peripapillary diverticula and colonic diverticula. Meckel diverticula can also be of relevance in adults. Diverticula have to be differentiated from intramural pseudodiverticulosis of the esophagus and bile duct cysts. An endoscopic and radiological diagnostic work-up is only necessary for symptomatic diverticula or complications. In some cases additional functional diagnostic tests, such as high-resolution esophageal manometry to detect underlying motility disorders (Zenker's diverticulum, epiphrenic diverticulum) or the hydrogen breath test to detect bacterial overgrowth in the small intestine (diverticula of the small intestine) are mandatory. Effective treatment requires the close interdisciplinary cooperation between different specialist disciplines. Therapeutic modalities include pharmacotherapy, endoscopy and surgical methods.
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Affiliation(s)
- Thomas Frieling
- Medizinische Klinik II, Klinik für Innere Medizin mit Gastroenterologie, Hepatologie, Infektiologie, Neurogastroenterologie, Gastrointestinaler Onkologie, Hämatoonkologie und Palliativmedizin, Helios Klinikum Krefeld, Lutherplatz 40, 47805, Krefeld, Deutschland.
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28
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Samanta J, Mandavdhare HS, Kumar N, Kumar-M P, Jafra A, Chauhan R, Gupta P, Kumar KH, Singh H, Dutta U, Kochhar R. Per Oral Endoscopic Myotomy for the Management of Large Esophageal Diverticula (D-POEM): Safe and Effective Modality for Complete Septotomy. Dysphagia 2021; 37:84-92. [PMID: 33533970 DOI: 10.1007/s00455-021-10252-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 01/13/2021] [Indexed: 01/26/2023]
Abstract
With the advent of the technique of sub-mucosal tunnelling, peroral endoscopic myotomy (POEM) has been used for the treatment of esophageal diverticulum, which otherwise is a recurring problem with conventional flexible endoscopic treatment due to incompleteness of septotomy. This study reports our experience of the use of diverticular POEM (D-POEM) technique in the management of large esophageal diverticulum. This is a retrospective study of prospectively maintained database including all consecutive patients with symptomatic esophageal diverticulum presenting at a tertiary care academic center. D-POEM was performed using the technique of submucosal tunnelling and septotomy. Besides baseline parameters, technical success, clinical success, size of diverticula, procedure time, complications and symptom recurrence on follow up were noted. A total of five patients (4 males; median age 72) were included with an average Charlson comorbidity index of 3.2 ± 0.8. Of them, three had Zenker's while two had epiphrenic diverticulum. The median symptom duration was 12 months with a mean diverticulum size of 68.8 ± 1.9 mm. The mean procedure time was 64.80 ± 12.6 min. with a mean septotomy/myotomy length of 79.44 ± 12.2 mm. Minor adverse events were noted intra-procedure in two cases. Clinical success achieved in all cases with a significant mean dysphagia score reduction from 2.20 to 0.20 post procedure (p = 0.011). On a median follow up of 280 days (range 98-330), none had recurrence of symptoms. Our data highlighted that complete septotomy by D-POEM technique can be achieved for the management of large esophageal diverticulum and is safe and effective.
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Affiliation(s)
- Jayanta Samanta
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India.
| | - Harshal S Mandavdhare
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
| | - Naveen Kumar
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
| | | | - Anudeep Jafra
- Department of Anaesthesiology, PGIMER, Chandigarh, India
| | - Rajeev Chauhan
- Department of Anaesthesiology, PGIMER, Chandigarh, India
| | - Pankaj Gupta
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
| | | | | | - Usha Dutta
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
| | - Rakesh Kochhar
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
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29
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Qi PX, Zou JN, Zhu J, Huang B, Xi EP, Gao XH. A Rare Giant Midesophageal Diverticulum: Fever is the Only Symptom. Risk Manag Healthc Policy 2021; 14:233-236. [PMID: 33519247 PMCID: PMC7837534 DOI: 10.2147/rmhp.s290568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 12/19/2020] [Indexed: 12/19/2022] Open
Abstract
A 55-year-old man was treated at the village hospital with six months medical history of recurrent chills and fever. Due to the lack of imaging examination, antipyretic and anti-infective medications were given. Although symptomatic treatment can relieve fever symptoms, symptoms easily flare up again two to three days after taking the drug. Later, the patient suffered from fever again during the COVID-19 epidemic and was sent to our hospital for isolation and treatment. During this hospitalization, chest CT examination is mandatory for all patients in order to meet the requirements of epidemic prevention and control. This led to the inadvertent discovery of a large cystic solid mass in the right thoracic cavity communicating with the esophageal lumen. The patient was preliminarily diagnosed as giant midesophageal diverticulum after three-dimensional CT image reconstruction of the chest was reviewed. Considering the patient’s persistent fever with poor nutritional status, we decided to temporarily place two gastric tubes (diverticulum decompression and gastrointestinal nutrition), and antibiotics were used at the same time as another main treatment. However, after the symptoms eased and nutritional status improved, he refused all further treatment. We believe that this patient’s diverticulum is very classic, and the treatment plan is highly integrated with the needs of epidemic prevention and control and achieves a satisfactory therapeutic effect, so we hope to provide colleagues with new diagnosis and treatment enlightenment through this case.
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Affiliation(s)
- Ping-Xin Qi
- School of Medicine, Wuhan University of Science and Technology, Wuhan 430065, People's Republic of China.,Department of Thoracic Cardiovascular Surgery, General Hospital of Central Theater Command of the People's Liberation Army, Wuhan 430070, People's Republic of China
| | - Jia-Ni Zou
- Department of Radiology, General Hospital of Central Theater Command of the People's Liberation Army, Wuhan 430070, People's Republic of China
| | - Jian Zhu
- Department of Thoracic Cardiovascular Surgery, General Hospital of Central Theater Command of the People's Liberation Army, Wuhan 430070, People's Republic of China
| | - Bin Huang
- The First School of Clinical Medicine, Southern Medical University, Guangzhou 510515, People's Republic of China
| | - Er-Ping Xi
- Department of Thoracic Cardiovascular Surgery, General Hospital of Central Theater Command of the People's Liberation Army, Wuhan 430070, People's Republic of China
| | - Xu-Hui Gao
- Department of Thoracic Cardiovascular Surgery, General Hospital of Central Theater Command of the People's Liberation Army, Wuhan 430070, People's Republic of China
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30
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Commentary: Transoral endoscopic repair of Zenker's diverticulum by a thoracic surgical service. J Thorac Cardiovasc Surg 2021; 163:1976-1977. [PMID: 33589312 DOI: 10.1016/j.jtcvs.2021.01.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/14/2021] [Accepted: 01/14/2021] [Indexed: 11/22/2022]
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31
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Shiu SI. Parapneumonic Effusion and Tension Pneumothorax after Diverticular Peroral Endoscopic Myotomy in a Woman with Large Epiphrenic Diverticulum: A Case Report and Literature Review. Clin Endosc 2021; 54:275-279. [PMID: 33445820 PMCID: PMC8039732 DOI: 10.5946/ce.2020.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/25/2020] [Indexed: 11/14/2022] Open
Abstract
Esophageal diverticula (ED) represents a group of rare conditions that warrant intervention when they are symptomatic or coexisting with pulmonary disorders. Few literature reviews have described this patient entity or discussed the postoperative outcome. Therefore, I present the case of a 59-year-old woman with symptoms of dysphagia who was significantly underweight, which was conducive to the diagnosis of symptomatic ED. Because she was a poor candidate for surgery, she received a diverticular peroral endoscopic myotomy. She subsequently developed parapneumonic effusion and tension pneumothorax after the procedure. She was finally discharged on postoperative day 23. I also performed the first known comprehensive literature review of 34 published cases (including my patient) from PubMed and have addressed the demography, intervention, and prognosis for symptomatic ED after the procedure. Prompt treatment as well as prognostic measurement are crucial to successful outcomes.
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Affiliation(s)
- Sz-Iuan Shiu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Evidence-based Practice and Policymaking Committee, Taichung Veterans General Hospital, Taichung, Taiwan
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32
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Miutescu BP, Khan S, Mony S, Khashab MA. Role of Peroral Endoscopic Myotomy (POEM) in the Management of Esophageal Diverticula. Clin Endosc 2020; 53:646-651. [PMID: 33238358 PMCID: PMC7719426 DOI: 10.5946/ce.2020.262] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 11/05/2020] [Indexed: 01/10/2023] Open
Abstract
Esophageal diverticula are uncommon; however, when present, they can cause symptoms of dysphagia, regurgitation, and chest pain. Based on location and pathophysiological characteristics, they are classified as pulsion- and traction-type diverticula. In the past, the open surgical approach was the only treatment available; however, in the past few decades, transoral incisionless approaches in the form of rigid and flexible endoscopy have gained popularity. Diverticular peroral endoscopic myotomy has emerged as an alternative treatment option. In this paper, we reviewed the role of peroral endoscopic myotomy as a treatment option for different types of esophageal diverticula. Although a safe and effective procedure, this novel submucosal tunneling technique for the treatment of esophageal diverticula requires further validation, and head-to-head comparisons between the different approaches for the treatment of esophageal diverticula are warranted.
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Affiliation(s)
- Bogdan P Miutescu
- Department of Gastroenterology and Hepatology, Victor Babeș University of Medicine and Pharmacy, Timișoara, Romania
| | - Sarah Khan
- Department of Medicine, Saint Agnes Hospital, Baltimore, MD, USA
| | - Shruti Mony
- Department of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Mouen A Khashab
- Department of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, MD, USA
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33
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Moreno Alfonso JC, Eguaras Córdoba I, Yárnoz Irazábal MC, Miranda Murua MDC. Divertículo esofágico de tercio medio: Una causa infrecuente de disfagia. REVISTA COLOMBIANA DE CIRUGÍA 2020. [DOI: 10.30944/20117582.562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Mujer de 72 años estudiada por cuadro clínico de 1 año de disfagia e impactación con alimentos sólidos que han requerido tratamiento endoscópico. Se realiza endoscopia de vías digestivas altas que documenta un divertículo esofágico en tercio medio, manometría esofágica de alta resolución sin trastorno motor. El esofagograma (fig. 1) y la tomografía axial computarizada de tórax (fig. 2) muestran un divertículo en tercio medio de esófago lateral derecho de 7 cm de diámetro y base de 2.5 cm de diámetro. De manera programada se lleva a cabo diverticulectomía esofágica toracoscópica sin complicaciones.
Los divertículos esofágicos son una patología infrecuente, con una prevalencia de 0.06-4%(1-4). Suelen ser asintomáticos, y en caso contrario lo más frecuente es la disfagia(2-4). Los divertículos medio esofágicos se forman por mecanismo de tracción y se asocian a procesos inflamatorios crónicos del mediastino, fibrosis y trastornos motores del esófago en un 90% de los casos; sin embargo se desconoce si el trastorno motor es primario o secundario a la presencia del divertículo(1,2,4). Puesto que suelen ser asintomáticos el diagnóstico es habitualmente incidental mediante esofagograma u otras pruebas radiológicas o endoscópicas y no precisan tratamiento(1-4); no obstante, ante la presencia de síntomas el tratamiento de elección es la resección quirúrgica por toracoscopia o toracotomía(2-4).
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34
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Nasef NA, Mehta S. Role of Inflammation in Pathophysiology of Colonic Disease: An Update. Int J Mol Sci 2020; 21:E4748. [PMID: 32635383 PMCID: PMC7370289 DOI: 10.3390/ijms21134748] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/28/2020] [Accepted: 07/01/2020] [Indexed: 02/06/2023] Open
Abstract
Diseases of the colon are a big health burden in both men and women worldwide ranging from acute infection to cancer. Environmental and genetic factors influence disease onset and outcome in multiple colonic pathologies. The importance of inflammation in the onset, progression and outcome of multiple colonic pathologies is gaining more traction as the evidence from recent research is considered. In this review, we provide an update on the literature to understand how genetics, diet, and the gut microbiota influence the crosstalk between immune and non‑immune cells resulting in inflammation observed in multiple colonic pathologies. Specifically, we focus on four colonic diseases two of which have a more established association with inflammation (inflammatory bowel disease and colorectal cancer) while the other two have a less understood relationship with inflammation (diverticular disease and irritable bowel syndrome).
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Affiliation(s)
- Noha Ahmed Nasef
- Riddet Institute, Massey University, Private Bag 11222, Palmerston North 4442, New Zealand
| | - Sunali Mehta
- Department of Pathology, Dunedin School of Medicine, University of Otago, Dunedin 9054, New Zealand
- Maurice Wilkins Centre for Biodiscovery, University of Otago, Dunedin 9054, New Zealand
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35
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Liu AQ, Chiu PWY. Third space endoscopy: Current evidence and future development. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2020. [DOI: 10.18528/ijgii200007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Alex Qinyang Liu
- Division of Upper GI and Metabolic Surgery, Department of Surgery, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Philip Wai Yan Chiu
- Division of Upper GI and Metabolic Surgery, Department of Surgery, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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36
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Tursi A, Scarpignato C, Strate LL, Lanas A, Kruis W, Lahat A, Danese S. Colonic diverticular disease. Nat Rev Dis Primers 2020; 6:20. [PMID: 32218442 PMCID: PMC7486966 DOI: 10.1038/s41572-020-0153-5] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2020] [Indexed: 12/12/2022]
Abstract
Diverticula are outpouchings of the intestinal wall and are common anatomical alterations detected in the human colon. Colonic diverticulosis (the presence of diverticula in the colon; referred to as diverticulosis) remains asymptomatic in most individuals but ~25% of individuals will develop symptomatic diverticulosis, termed colonic diverticular disease (also known as diverticular disease). Diverticular disease can range in severity from symptomatic uncomplicated diverticular disease (SUDD) to symptomatic disease with complications such as acute diverticulitis or diverticular haemorrhage. Since the early 2000s, a greater understanding of the pathophysiology of diverticulosis and diverticular disease, which encompasses genetic alterations, chronic low-grade inflammation and gut dysbiosis, has led to improvements in diagnosis and management. Diagnosis of diverticular disease relies on imaging approaches, such as ultrasonography, CT and MRI, as biomarkers alone are insufficient to establish a diagnosis despite their role in determining disease severity and progression as well as in differential diagnosis. Treatments for diverticular disease include dietary fibre, pharmacological treatments such as antibiotics (rifaximin), anti-inflammatory drugs (mesalazine) and probiotics, alone or in combination, and eventually surgery. Despite being effective in treating primary disease, their effectiveness in primary and secondary prevention of complications is still uncertain.
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Affiliation(s)
- Antonio Tursi
- Territorial Gastroenterology Service, Azienda Sanitaria Locale Barletta-Andria-Trani, Andria, Italy.
| | - Carmelo Scarpignato
- Faculty of Health Sciences, LUdeS Lugano Campus, Lugano, Switzerland
- United Campus of Malta, Birkirkara, Msida, Malta
| | - Lisa L Strate
- Division of Gastroenterology, Department of Medicine, Harborview Medical Center, University of Washington Medical School, Seattle, WA, USA
| | - Angel Lanas
- Service of Digestive Diseases, University Clinic Hospital Lozano Blesa, University of Zaragoza, IIS Aragón (CIBERehd), Zaragoza, Spain
| | | | - Adi Lahat
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, affiliated with Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Silvio Danese
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center - IRCCS -, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
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37
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Holmes I, Ko MS, Kouanda A, Singh A, Nett A, Kathpalia P. Epiphrenic diverticula: An added source of complexity in achalasia management. Neurogastroenterol Motil 2020; 32. [PMID: 31777144 DOI: 10.1111/nmo.13761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/16/2019] [Accepted: 10/23/2019] [Indexed: 02/08/2023]
Abstract
Epiphrenic (pulsion) esophageal diverticula can occur in the setting of underlying esophageal motility disorders such as achalasia and present a unique management challenge to the gastroenterologist. Asymptomatic diverticula do not require treatment, but symptomatic diverticula require therapy targeted to the underlying esophageal motility disorder, or else the diverticula will recur. Generally, laparoscopic or combined laparoscopic/thoracoscopic myotomy, diverticulectomy, and anterior fundoplication are required. However, therapeutic options for epiphrenic diverticula are evolving as peroral endoscopic myotomy (POEM) becomes more commonplace. We review two cases of achalasia complicated by epiphrenic diverticula at our institution. In the first case, type II achalasia was identified and the patient underwent laparoscopic myotomy. In the second case, type III achalasia was present and the patient underwent successful POEM. We discuss the presentation, pathophysiology, and management of epiphrenic diverticula as well as the expanding role for POEM in diverticula.
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Affiliation(s)
- Ian Holmes
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California - San Francisco, San Francisco, California
| | - Myung S Ko
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California - San Francisco, San Francisco, California
| | - Abdul Kouanda
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California - San Francisco, San Francisco, California
| | - Aparajita Singh
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California - San Francisco, San Francisco, California
| | - Andrew Nett
- Division of Gastroenterology and Hepatology, Department of Medicine, California Pacific Medical Center, San Francisco, California
| | - Priya Kathpalia
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California - San Francisco, San Francisco, California
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38
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Bhalla S, Reddy CA, Watts L, Chang AC, Law R. Greater-curvature peroral endoscopic myotomy with diverticuloseptotomy for the treatment of achalasia in a patient with a large epiphrenic diverticulum. VideoGIE 2019; 5:77-79. [PMID: 32051916 PMCID: PMC7003126 DOI: 10.1016/j.vgie.2019.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Sean Bhalla
- Department of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Chanakyaram A Reddy
- Department of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Lydia Watts
- Department of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew C Chang
- Section of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Ryan Law
- Department of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
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