scholarly journals Endoscopic treatment of Zenker’s diverticulum with Ligasure: simple, safe and effective

2019 ◽  
Vol 07 (02) ◽  
pp. E203-E208 ◽  
Author(s):  
Pilar Diez Redondo ◽  
Henar Núñez Rodríguez ◽  
Marina de Benito Sanz ◽  
Raúl Torres Yuste ◽  
Manuel Pérez-Miranda
Keyword(s):  
Clinical Success ◽  
The Elderly ◽  
Flexible Endoscopy ◽  
Zenker’S Diverticulum ◽  
Delayed Bleeding ◽  
Zenker's Diverticulum ◽  
Second Procedure ◽  
Tissue Sealing

Abstract Background and study aims Zenker's diverticulum may cause disabling symptoms, especially in the elderly. Treatment has changed in recent decades from open surgery to management with flexible endoscopy, resulting in lower morbidity and mortality. The goal of this study was to present the largest series, with the longest follow-up, of patients with Zenker's diverticulum receiving outpatient treatment with flexible endoscopy using a diverticuloscope and Ligasure (Covidien, Minneapolis, Minnesota, United States), a device that allows tissue sealing and coagulation of vessels before cutting the septum between the diverticulum and esophagus. Patients and methods We performed 79 diverticulotomies in 69 patients (65.2 % male, mean age 73.4 years). The mean diverticulum size was 2.8 cm. In three cases with a diverticulum ≤ 1.5 cm, the diverticuloscope could not be placed. Results The technical success was 95.83 % and the clinical success 96.7 %: 84 % of the 56 patients followed for a mean of 34.6 months (24 – 64 months) had no dysphagia. The recurrence rate was 10.4 %, with a good response to a second diverticulotomy at 12 months (IQR: 11.5 – 17) in most cases. The most severe complications were two microperforations, resolved with conservative treatment, and one case of delayed bleeding endoscopically-controlled with a clip. Conclusions Diverticulotomy of the esophageal-diverticular septum with Ligasure is an outpatient endoscopic technique that is simple, effective in the long term and very safe for the treatment of patients with Zenker's diverticulum. In symptomatic recurrences, a second procedure was equally safe and effective in most patients.

Endoscopic Treatment With a Soft Diverticuloscope for Zenker's Diverticulum: Long Term Follow up

2011 ◽  
Vol 140 (5) ◽  
pp. S-227
Author(s):  
Vincent Huberty ◽  
Souraya El Bacha ◽  
Sergio Hassid ◽  
Daniel Blero ◽  
Olivier Le Moine ◽  
...  
Keyword(s):  
Endoscopic Treatment ◽  
Zenker’S Diverticulum ◽  
Zenker's Diverticulum ◽  
Long Term Follow Up

Endotherapy of Zenker’s diverticulum using the needle-knife technique: long-term follow-up

Endoscopy ◽  
2006 ◽  
Vol 39 (02) ◽  
pp. 131-136 ◽  
Author(s):  
A. Vogelsang ◽  
C. Preiss ◽  
H. Neuhaus ◽  
B. Schumacher
Keyword(s):  
Zenker’S Diverticulum ◽  
Zenker's Diverticulum ◽  
Long Term Follow Up ◽  
Needle Knife

Impact of prior treatment on feasibility and outcomes of Zenker’s peroral endoscopic myotomy (Z-POEM)

Endoscopy ◽  
2020 ◽  
Author(s):  
Omid Sanaei ◽  
Yervant Ichkhanian ◽  
Oscar V. Hernández Mondragón ◽  
Jose Nieto ◽  
Arunkumar Krishnan ◽  
...  
Keyword(s):  
Complete Resolution ◽  
Primary Outcome ◽  
Surgical Intervention ◽  
Clinical Success ◽  
Peroral Endoscopic Myotomy ◽  
Zenker’S Diverticulum ◽  
Dysphagia Score ◽  
Zenker's Diverticulum ◽  
Endoscopic Myotomy

Abstract Background Zenker’s peroral endoscopic myotomy (Z-POEM) is a novel procedure for the management of symptomatic Zenker’s diverticulum. This study aims to report the technical feasibility and outcomes of Z-POEM in the management of Zenker’s diverticulum after prior failed interventions. Methods Patients with persistent or recurrent symptoms after prior endoscopic and/or surgical intervention for Zenker’s diverticulum were retrospectively included. The primary outcome was clinical success, defined as complete or near complete resolution of dysphagia (dysphagia score of 0 or 1) without the need for repeat endoscopic or surgical intervention during follow-up. Results Z-POEM was technically successful in 30/32 patients (93.8 %). Clinical success was achieved in 29/30 patients (96.7 %), and Z-POEM significantly reduced the median (interquartile range [IQR]) dysphagia score of patients from 2 (1 – 2) to 0 (0) (P < 0.001) over a median duration of follow up of 166 days (IQR 39 – 566). Four patients (12.5 %) had adverse events (two inadvertent mucosotomies and two leaks found on post-procedural esophagrams). Conclusion Z-POEM is feasible, safe, and effective in the majority of patients with recurrent symptoms after prior surgical or endoscopic interventions.

scholarly journals Endoscopic management of Zenker’s diverticulum

2015 ◽  
Vol 06 (02) ◽  
pp. 045-054 ◽  
Author(s):  
Harpal S. Dhaliwal ◽  
Saroj K. Sinha ◽  
Rakesh Kochhar
Keyword(s):  
Flexible Endoscopy ◽  
Endoscopic Management ◽  
Zenker’S Diverticulum ◽  
Mortality And Morbidity ◽  
Endoscopic Techniques ◽  
Zenker's Diverticulum ◽  
Neck Anatomy ◽  
Endoscopic Myotomy ◽  
Underlying Pathophysiology

AbstractZenker’s diverticulum (ZD) is a posterior hypopharyngeal mucosal and submucosal outpouching through an area of relative muscular weakness, known as Killian’s triangle. It is an uncommon but highly treatable cause of mechanical dysphagia in elderly patients. Diagnosis is established by esophagography and upper endoscopy. The treatment has evolved with the advancement in the understanding of underlying pathophysiology. Traditionally, the management had been open surgical exposure and cricopharyngeal myotomy, combined with diverticular excision, suspension or inversion. Peroral endoscopic techniques (rigid and flexible) have gained popularity as minimally invasive and effective therapeutic options, with lesser mortality and morbidity. Flexible endoscopic myotomy offers additional benefits over rigid endoscopic techniques, as it does not require general anesthesia and neck hyperextension. The initial results of flexible endoscopy are quite encouraging, but long-term data are not yet available. For the optimal outcome, flexible endotherapy requires a formidable endoscopic skill, sound knowledge of the neck anatomy and meticulous understanding of the electrosurgical principles. In this article, we have comprehensively reviewed the current understanding of the pathophysiology involved and various techniques used in the management of ZD, with a focus on flexible endoscopic techniques.

S175 – Endoscopic and Open Approaches for Zenker's Diverticulum

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P134-P135
Author(s):  
Rahul Seth ◽  
Carl Koch ◽  
Robert R Lorenz ◽  
Joseph Scharpf ◽  
Walter Lee
Keyword(s):  
Statistical Significance ◽  
Symptom Relief ◽  
Complete Response ◽  
Phone Call ◽  
Zenker’S Diverticulum ◽  
Recurrent Pneumonia ◽  
Zenker's Diverticulum ◽  
Persistent Symptoms

Objectives To compare 1) long-term symptomatic outcomes and 2) patient satisfaction between open-neck surgery and endoscopic stapling diverticulotomy (ESD) for Zenker's diverticulum. Methods Patients undergoing operation for Zenker's diverticulum during the last 10 years (1998 through 2007) at our institution were telephoned and questioned of dysphagia, coughing and choking, regurgitation, halitosis, weight loss, and recurrent pneumonia based on a validated Gastrointestinal Quality-of-Life Index. Symptom degree pre-operatively, one-month postoperatively, and time of phone call were recorded. Results 39 of 81 patients were contacted. Of these, 14 underwent ESD and 25 had open-neck procedures. Average follow-up time was longer for the open-neck group (4.6 vs. 1.8 years, p<0.01, t-test). Age at operation, diverticulum size, pre-operative symptom scores, and long-term follow-up scores at phone call were not statistically different between the two groups. When patients were asked if symptom relief was complete, improved, unchanged, or worse, a greater proportion of open-neck patients claimed a complete response (67% vs. 43%, p=0.09, contingency analysis) at longer follow-up times. The recurrence of symptoms leading to re-operation was higher for ESD (4 versus 2). Conclusions Long-term symptomatic outcomes between the 2 populations are similar. However, a greater proportion of patients with open-neck procedures claimed complete response. Since the Zenker's location is unchanged in ESD, this may explain persistent symptoms the patient may be experiencing. Greater patient numbers are needed for statistical significance.

Laparoscopic Incisional and Ventral Hernia Repair with Absorbable Tacks in a Long Term Follow-up: A Retrospective Control Study

2019 ◽  
Vol 14 (2) ◽  
pp. 141-146
Author(s):  
Simone Zanella ◽  
Enrico Lauro ◽  
Francesco Franceschi ◽  
Francesco Buccelletti ◽  
Annalisa Potenza ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Ventral Hernia ◽  
Ventral Hernia Repair ◽  
The Elderly ◽  
Long Term Follow Up ◽  
Group A ◽  
Group B ◽  
Absorbable Tacks

Background: Laparoscopic Incisional and Ventral Hernia Repair (LIVHR) is a safe and worldwide accepted procedure performed using absorbable tacks. The aim of the study was to evaluate recurrence rate in a long term follow-up and whether the results of laparoscopic IVH repair in the elderly (≥65 years old) are different with respect to results obtained in younger patients. Methods: One hundred and twenty-nine consecutive patients (74 women and 55 men, median age 67 years, range = 30-87 years) with ventral (N = 42, 32.5%) or post incisional (N = 87, 67.5%) hernia were enrolled in the study. Patients were divided into two groups according to their age: group A (N = 55, 42.6%) aged <65 years and group B (N = 74, 57.4%) aged ≥65 years. Results: The mean operative time was not significantly different between groups (66.7 ± 37 vs. 74 ± 48.4 min, p = 0.4). To the end of 2016, seven recurrences had occurred (group A = 3, group B = 4, p = 1). Complications occurred in 8 (16%) patients in group A and 21 (28.3%) patients in group B. Conclusion: In conclusion, our results confirm that the use of absorbable tacks does not increase recurrence frequency and laparoscopic incisional and ventral repair is a safety procedure also in elderly patients.

scholarly journals Experience and Technique for Zenker's Diverticulum Per Oral Endoscopic Myotomy: Z-POEM

2020 ◽  
Author(s):  
Eitan Podgaetz ◽  
Vani Konda
Keyword(s):  
Third Space ◽  
Zenker’S Diverticulum ◽  
Complication Rates ◽  
Short Term ◽  
Zenker's Diverticulum ◽  
Per Oral Endoscopic Myotomy ◽  
Endoscopic Myotomy ◽  
Invasive Techniques ◽  
Per Oral

Abstract Objective With the advent of minimally invasive surgery, incisionless surgery, and third-space endoscopy, the treatment for Zenker's diverticulum has also moved toward less invasive techniques Methods New incisionless per oral techniques can be applied for cricopharyngeal myotomy in Zenker's diverticulum. Results Five patients underwent Zenker's diverticulum per oral endoscopic myotomy (Z-POEM) without complications, minimal discomfort, and narcotic consumption, with complete resolution of their symptoms by history and Eckardt scores. Conclusions Z-POEM is performed entirely endoscopically with very little associated pain or complication rates, with short-term follow-up having excellent functional and symptomatic results.

scholarly journals 10-Year Follow-Up of a Patient with Cerebral Amyloid Angiopathy

2020 ◽  
Vol 12 (Suppl. 1) ◽  
pp. 202-206
Author(s):  
Min Kyoung Kang ◽  
Byung-Woo Yoon
Keyword(s):  
Cerebral Amyloid Angiopathy ◽  
The Elderly ◽  
Amyloid Angiopathy ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Radiological Features ◽  
Magnetic Imaging ◽  
Long Term Follow Up ◽  
Cerebral Amyloid

We report the case of long-term follow-up of brain magnetic imaging of cerebral amyloid angiopathy. Cerebral amyloid angiopathy is often considered a major cause of spontaneous intracerebral hemorrhage in the elderly. This case illustrates the markedly progressive clinical and radiological features of the vasculopathic process in 10 years.

scholarly journals Impact of Frailty on Medical and Long-Term Care Expenditures for the Elderly Age 75 or Over in Japan

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 176-176
Author(s):  
Hiroto Yoshida ◽  
Yuriko Kihara
Keyword(s):  
Long Term Care ◽  
The Elderly ◽  
Elderly Age ◽  
Term Care ◽  
Intentional Weight Loss ◽  
Long Term Care Insurance ◽  
And Gender ◽  
The Impact

Abstract This study examined the impact of frailty on medical and long-term care expenditures in an older Japanese population. The subjects were those aged 75 years and over who responded to the survey (March 2018) in Bibai, Hokkaido, Japan (n=1,203) and have never received certification of long-term care insurance at the survey. We followed up 867 individuals (72.1%) until the end of December 2018 (10 month-period). We defined frailty as a state in performing 4 items and over of 15 items which were composed of un-intentional weight loss, history of falls, etc. Among 867 subjects, 233 subjects (26.9%) were judged to be frailty group, and 634 subjects (73.1%) non-frailty group. We compared period to the new certification of long-term care insurance (LTCI), accumulated medical and long-term care expenditures adjusted for age and gender between the two groups during the follow-up period. Cox proportional hazard models were used to examine the association between baseline frailty and the new certification of LTCI. The relative hazard ratio (HR) was higher in frailty group than non-frailty group (HR=3.51, 95% CI：1.30-9.45, P=.013). The adjusted mean accumulated medical and long-term care expenditures per capita during the follow-up were significantly (P=.002) larger for those in the frailty group (629,699 yen), while those in the non-frailty group were 450,995 yen. We confirmed strong economic impact of frailty in the elderly aged 75 or over in Japan.

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