Notícias

Divertículo de Zenker: divisão endoscópica do septo por tunelamento submucoso

fonte: WEO

Autores: Oscar Víctor Hernández Mondragón; Michel Omar Solórzano Pineda; Juan Manuel Blancas Valencia

Brief Explanation

Zenker’s diverticulum is characterized by dysphagia, weight loss and bronchoaspiration.1 Open surgery has been the cornerstone of treatment with good response but recurrence of up to 35%.2 Rigid endoscopic diverticulotomy has similar results, but with conversion to open surgery of up to 30%.3 Flexible endoscopic diverticulotomy is safe, effective and can be carried out in an endoscopic setting, but multiple sessions are needed because of incomplete cutting of the septum.4, 5 Z‐POEM is a new procedure in which a total septum myotomy throughout a submucosal tunnel can be carried out. We describe this technique in an 85 year‐old‐man with large Zenker′s diverticulum.

After confirmation of a 35‐mm Zenker′s diverticulum, we carried out the procedure using an electrosurgical unit ERBE model VIO‐200D (Tübingen, Germany), a regular endoscope coupled with a homemade cap and a CO2 insufflator. Flush knife model DK2618J (Fujinon, Tokyo, Japan), a sclerotherapy needle (Boston Scientific, Marlborough, MA, USA), and resolution clips (Boston Scientific).

Technique: First, creation of a submucosal bleb 3 cm above the septum with a 10‐mm longitudinal incision. Second, submucosal tunnel was created up to the diverticular septum. Third, total myotomy of the septum and fourth, a mucosal closure was carried out with five clips. Characteristics of the procedure were documented.

Z‐POEM was carried out successfully without adverse events during or after the procedure. Barium esophagram test showed a decrease of more than 80% of the original diverticular size (6 mm), and no bronchoaspiration signs were observed. The patient was discharged at 48 h after Z‐POEM and, 1 month later, no dysphagia was observed and the patient could eat a normal diet.

Z‐POEM or so‐called submucosal tunneling endoscopic septum division technique is a safe and effective procedure for the treatment of Zenker′s diverticulum with the advantages of a complete septum division, faster recovery and can be carried out in patients with different diverticular sizes and even in those with high comorbidities.

Authors declare no conflicts of interest for this article.

 

 

dsadsadsdsa