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Zenker’s diverticulum: advancing beyond the tunnel

BACKGROUND AND AIMS: Zenker’s diverticulum (ZD) is attributed to a poorly compliant cricopharyngeus muscle, and the mainstay of treatment is a cricopharyngeal myotomy. We present a video series summarizing endoscopic treatment options for ZD and related conditions. METHODS: We review the rationale a...

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Autores principales: Zhang, Linda Y., Nieto, Jose, Ngamruengphong, Saowanee, Repici, Alessandro, Khashab, Mouen A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8646134/
https://www.ncbi.nlm.nih.gov/pubmed/34917870
http://dx.doi.org/10.1016/j.vgie.2021.08.003
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author Zhang, Linda Y.
Nieto, Jose
Ngamruengphong, Saowanee
Repici, Alessandro
Khashab, Mouen A.
author_facet Zhang, Linda Y.
Nieto, Jose
Ngamruengphong, Saowanee
Repici, Alessandro
Khashab, Mouen A.
author_sort Zhang, Linda Y.
collection PubMed
description BACKGROUND AND AIMS: Zenker’s diverticulum (ZD) is attributed to a poorly compliant cricopharyngeus muscle, and the mainstay of treatment is a cricopharyngeal myotomy. We present a video series summarizing endoscopic treatment options for ZD and related conditions. METHODS: We review the rationale and key technique for various endoscopic treatment modalities for ZD, cricopharyngeal bar, and other esophageal diverticula. RESULTS: Standard flexible endoscopic cricopharyngeal myotomy involves the division of the common wall or septum of the ZD, aiming for complete transection of the cricopharyngeus. However, recurrence rates are high, likely owing to incomplete myotomy. Zenker’s peroral endoscopic myotomy (Z-POEM) uses a proximal submucosal tunnel to provide direct visualization of the cricopharyngeus and septum, allowing confirmation of complete myotomy. We demonstrate an over-the-septum modification to simplify the technique. Submucosal fibrosis, commonly seen in patients with prior treatment, limits submucosal dissection. We present a hybrid technique to overcome this, whereby a traditional septotomy is performed until submucosal tissue is visualized. The intact mucosal flap after Z-POEM in a large ZD may contribute to residual dysphagia. We propose Z-POEM with mucosotomy for large ZD. Finally, we demonstrate modifications for treatment of other esophageal diseases, including cricopharyngeal bar and non-Zenker’s esophageal diverticula. CONCLUSION: Endoscopic treatment options for ZD and related conditions are rapidly expanding. With careful tailoring to individual patient characteristics, our expanding arsenal of options allows effective and safe treatment of a broad spectrum of patients.
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spelling pubmed-86461342021-12-15 Zenker’s diverticulum: advancing beyond the tunnel Zhang, Linda Y. Nieto, Jose Ngamruengphong, Saowanee Repici, Alessandro Khashab, Mouen A. VideoGIE Video Case Series BACKGROUND AND AIMS: Zenker’s diverticulum (ZD) is attributed to a poorly compliant cricopharyngeus muscle, and the mainstay of treatment is a cricopharyngeal myotomy. We present a video series summarizing endoscopic treatment options for ZD and related conditions. METHODS: We review the rationale and key technique for various endoscopic treatment modalities for ZD, cricopharyngeal bar, and other esophageal diverticula. RESULTS: Standard flexible endoscopic cricopharyngeal myotomy involves the division of the common wall or septum of the ZD, aiming for complete transection of the cricopharyngeus. However, recurrence rates are high, likely owing to incomplete myotomy. Zenker’s peroral endoscopic myotomy (Z-POEM) uses a proximal submucosal tunnel to provide direct visualization of the cricopharyngeus and septum, allowing confirmation of complete myotomy. We demonstrate an over-the-septum modification to simplify the technique. Submucosal fibrosis, commonly seen in patients with prior treatment, limits submucosal dissection. We present a hybrid technique to overcome this, whereby a traditional septotomy is performed until submucosal tissue is visualized. The intact mucosal flap after Z-POEM in a large ZD may contribute to residual dysphagia. We propose Z-POEM with mucosotomy for large ZD. Finally, we demonstrate modifications for treatment of other esophageal diseases, including cricopharyngeal bar and non-Zenker’s esophageal diverticula. CONCLUSION: Endoscopic treatment options for ZD and related conditions are rapidly expanding. With careful tailoring to individual patient characteristics, our expanding arsenal of options allows effective and safe treatment of a broad spectrum of patients. Elsevier 2021-09-15 /pmc/articles/PMC8646134/ /pubmed/34917870 http://dx.doi.org/10.1016/j.vgie.2021.08.003 Text en © 2021 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Video Case Series
Zhang, Linda Y.
Nieto, Jose
Ngamruengphong, Saowanee
Repici, Alessandro
Khashab, Mouen A.
Zenker’s diverticulum: advancing beyond the tunnel
title Zenker’s diverticulum: advancing beyond the tunnel
title_full Zenker’s diverticulum: advancing beyond the tunnel
title_fullStr Zenker’s diverticulum: advancing beyond the tunnel
title_full_unstemmed Zenker’s diverticulum: advancing beyond the tunnel
title_short Zenker’s diverticulum: advancing beyond the tunnel
title_sort zenker’s diverticulum: advancing beyond the tunnel
topic Video Case Series
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8646134/
https://www.ncbi.nlm.nih.gov/pubmed/34917870
http://dx.doi.org/10.1016/j.vgie.2021.08.003
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