The choice of the endoscopic method of treatment of Zenker's diverticulum depending on its size

Aims Zenker's diverticulum is a rare disease with a frequency of 1:10,000 of the population. Today, endoscopic treatment can be considered the gold standard, but the recurrence rate after endoscopic treatment remains high and depends on the size of the diverticulum.

Methods 18 patients with Zenker's diverticula of various sizes, from 3.0 to 11 sm, took part in our research for the period of 2023-2024. The patients were divided into two groups, the first group included 7 patients with diverticula whose size was on average from 3 to 5 cm, the second group included 11 patients who had diverticula from 5 to 11 cm in size. The size of the diverticulum was estimated by X-ray and endoscopic data. All operations were performed under general anesthesia in the supine position and antibiotic prophylaxis. The degree of dysphagia was assessed according to the Eckhard School, in the first group it was 4-5 points and in the second 6-7 [1] [2] [3] [4].

Results in the first group, we used the Z-POEM free tunnel method, which made it possible to reduce the operation time from 40 minutes to 15-20 minutes. There were no complications during the operation, the wound was closed with 4-5 hemostatic clips. No recurrence was observed during observation. In the second group, patients underwent Z-POEM+mucosotomy method. Mucosotomy was performed in all patients with large diverticul, mucosotomy was performed to the bottom of the diverticulum, both from the side of the diverticulum and from the side of the esophagus. The dissected mucosa was closed with hemostatic clips in the form of a horseshoe. Depending on the size, the number of clips could be from 7 to 20 clips. There were no complications during the operation. In the long-term follow-up, only two patients with diverticula measuring 10 and 11 cm were diagnosed with dysphagia, 4 months after the operation, which was due to insufficient mucosotomy. During the control endoscopic examination, we observed a mucous bridge, which was re-dissected.

Conclusions according to our data, we can conclude that Z-POEM free tunnel is an effective method in the treatment of diverticula up to 5 sm in size, with a reduction in the time of surgery and hospital stay. For large diverticula, the Z-POEM method with mandatory mucosotomy is effective, which gives a low percentage of recurrence in the distant observed. Patients in both groups have symptoms of dysphagia according to the scale Eckhard decreased and was at the level of 0-2 points, which indicates the effectiveness of endoscopic treatment.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

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