Practice patterns, techniques, and outcomes of flexible endoscopic myotomy for Zenker’s diverticulum: a retrospective multicenter study

Abstract Background Flexible endoscopic myotomy has been increasingly performed for Zenker’s diverticulum using various endoscopic techniques and devices. The main aims of this study were to assess practice patterns and compare outcomes of endoscopic myotomy for Zenker’s diverticulum. Methods Procedures performed at 12 tertiary endoscopy centers from 1/2012 to 12/2018 were reviewed. Patients (≥ 18 years) with Zenker’s diverticulum who had dysphagia and/or regurgitation and underwent endoscopic myotomy were included. Outcomes assessed included technical success, clinical success, and adverse events. Results 161 patients were included. Traditional endoscopic septotomy was performed most frequently (137/161, 85.1 %) followed by submucosal dissection of the septum and myotomy (24/161, 14.9 %). The hook knife (43/161, 26.7 %) and needle-knife (33/161, 20.5 %) were used most frequently. Overall, technical and clinical success rates were 98.1 % (158/161) and 78.1 % (96/123), respectively. Adverse events were noted in 13 patients (8.1 %). There was no significant difference in technical and clinical success between traditional septotomy and submucosal dissection groups (97.1 % vs. 95.8 %, P = 0.56 and 75.2 % vs. 90.9 %, P = 0.16, respectively). Clinical success was higher with the hook knife (96.7 %) compared with the needle-knife (76.6 %) and insulated tip knife (47.1 %). Outcomes were similar between centers performing > 20, 11 – 20, and ≤ 10 procedures. Conclusions Flexible endoscopic myotomy is an effective therapy for Zenker’s diverticulum, with a low rate of adverse events. There was no significant difference in outcomes between traditional septotomy and a submucosal dissection approach, or with centers with higher volume, though clinical success was higher with the hook knife.

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Percutaneous cholecystostomy for biliary decompression in patients with cholangitis and pancreatitis

Journal of International Medical Research ◽

10.1177/0300060518786632 ◽

2018 ◽

Vol 46 (10) ◽

pp. 4120-4128 ◽

Cited By ~ 5

Author(s):

Jin Myung Park ◽

Chang Don Kang ◽

Minjong Lee ◽

Sung Chul Park ◽

Sung Joon Lee ◽

...

Keyword(s):

Adverse Event ◽

Adverse Events ◽

Biliary Obstruction ◽

Clinical Success ◽

Adverse Event Rate ◽

Serum Total Bilirubin ◽

Percutaneous Cholecystostomy ◽

Success Rates ◽

Biliary Decompression ◽

Significant Difference

Objective This study was performed to assess the effectiveness and safety of percutaneous cholecystostomy (PC) for biliary decompression. Methods We retrospectively analyzed our institution’s PC database from March 2015 to August 2017 and selected patients with biliary obstruction. The primary outcomes were the technical and clinical success rates. As secondary outcomes, adverse events and pain after PC were compared with those of patients who underwent PC for acute cholecystitis during the same period. Results Twenty patients underwent PC for biliary obstruction (cholangitis, 19; pancreatitis, 1). The technical and clinical success rates were 100%. The median serum total bilirubin level decreased considerably from 4.5 to 1.4 mg/dL after PC. An adverse event (catheter migration) occurred in 1 patient, and 17 patients developed pain after PC. During the same period, 104 patients underwent PC for cholecystitis. Adverse events occurred in 7 patients, and 62 developed pain. There was no significant difference in the adverse event rate between the cholangitis/pancreatitis and cholecystitis groups (5.0% vs. 6.7%, respectively), but pain occurred considerably more frequently in the cholangitis/pancreatitis group (94.4% vs. 63.9%, respectively). Conclusions PC is an effective and safe method for biliary decompression in selected patients. However, attention should be paid to postoperative pain.

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

Endoscopy ◽

10.1055/a-1276-0219 ◽

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.

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A novel method to perform endoscopic myotomy for Zenker’s diverticulum using submucosal dissection techniques

Endoscopy ◽

10.1055/s-0034-1377967 ◽

2014 ◽

Vol 46 (12) ◽

pp. 1119-1121 ◽

Cited By ~ 5

Author(s):

Prashant Kedia ◽

Norio Fukami ◽

Nikhil Kumta ◽

Michel Kahaleh ◽

Reem Sharaiha

Keyword(s):

Zenker’S Diverticulum ◽

Zenker's Diverticulum ◽

Submucosal Dissection ◽

Novel Method ◽

Endoscopic Myotomy ◽

Dissection Techniques

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

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0040-1717127 ◽

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.

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Per-oral endoscopic dual myotomy for the treatment of achalasia

Esophagus ◽

10.1007/s10388-021-00863-9 ◽

2021 ◽

Author(s):

Xianglei Yuan ◽

Zhe Feng ◽

Yanshi Zhao ◽

Xianhui Zeng ◽

Liansong Ye ◽

...

Keyword(s):

Adverse Events ◽

Clinical Success ◽

Mucosal Injury ◽

Single Session ◽

Eckardt Score ◽

Endoscopic Myotomy ◽

Favorable Safety ◽

Per Oral ◽

Disease Questionnaire

Abstract Background Repeat per-oral endoscopic myotomy is occasionally performed for persistent/recurrent symptoms in patients with achalasia, and yields favorable outcomes. We investigated a novel technique, per-oral endoscopic dual myotomy (dual-POEM), where a second myotomy was performed during a single session to augment the efficacy and avoid repeat interventions. The aim of this study was to evaluate its feasibility, safety and efficacy. Methods Consecutive patients diagnosed with achalasia who underwent dual-POEM (1/2018–5/2019) were prospectively collected and retrospectively analyzed. Patients with baseline Eckardt score ≥ 9, ≥ 10 years of symptoms, and/or having prior interventions other than myotomy received dual-POEM. The primary outcome was clinical success (Eckardt score ≤ 3). Secondary outcomes were procedure-related adverse events, change in lower esophageal sphincter (LES) pressure, and reflux complications. Results Seventeen patients received dual-POEM. Procedure-related adverse events were observed in 2 (11.8%) patients (mucosal injury and pneumonitis). Both were minor in severity. During a median follow-up of 33 months (interquartile range, IQR [31,35]; range, 19–36), clinical success was achieved in 16 (94.1%) patients. The median Eckardt score decreased from 9 (IQR [8, 11.5]; range 7–12) to 1 (IQR [1, 2]; range 0–4) (P < 0.001), and LES pressure decreased from 25.8 mmHg (IQR [21.7, 33.5]; range 17.7–46.3) to 7.4 mmHg (IQR [6.3, 10.4]; range 2.2–12.6) (P < 0.001). Seven (41.2%) patients developed postprocedural reflux either by gastroesophageal reflux disease questionnaire or esophagitis endoscopically, all successfully treated with proton pump inhibitors. Conclusion Dual-POEM preliminarily demonstrated high efficacy with a favorable safety profile in patients with achalasia with predictors of treatment failure.

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Impact of Physician Training Level on Neonatal Tracheal Intubation Success Rates and Adverse Events: A Report from National Emergency Airway Registry for Neonates (NEAR4NEOS)

Neonatology ◽

10.1159/000516372 ◽

2021 ◽

pp. 1-9

Author(s):

Lindsay Johnston ◽

Taylor Sawyer ◽

Anne Ades ◽

Ahmed Moussa ◽

Jeanne Zenge ◽

...

Keyword(s):

Tracheal Intubation ◽

Adverse Events ◽

Multivariable Analysis ◽

Estimating Equation ◽

Oxygen Desaturation ◽

Physician Training ◽

Training Level ◽

Success Rates ◽

Emergency Airway ◽

Significant Difference

Introduction: Neonatal tracheal intubation (TI) outcomes have been assessed by role, but training level may impact TI success and safety. Effect of physician training level (PTL) on the first-attempt success, adverse TI-associated events (TIAEs), and oxygen desaturation was assessed. Methods: Prospective cohort study in 11 international NEAR4NEOS sites between October 2014 and December 2017. Primary TIs performed by pediatric/neonatal physicians were included. Univariable analysis evaluated association between PTL, patient/practice characteristics, and outcomes. Multivariable analysis with generalized estimating equation assessed for independent association between PTL and outcomes (first-attempt success, TIAEs, and oxygen desaturation ≥20%; attending as reference). Results: Of 2,608 primary TIs, 1,298 were first attempted by pediatric/neonatal physicians. PTL was associated with patient age, weight, comorbidities, TI indication, difficult airway history, premedication, and device. First-attempt success rate differed across PTL (resident 23%, fellow 53%, and attending 60%; p < 0.001). There was no statistically significant difference in TIAEs (resident 22%, fellow 20%, and attending 25%; p = 0.34). Desaturation occurred more frequently with residents (60%), compared to fellows and attendings (46 and 53%; p < 0.001). In multivariable analysis, adjusted odds ratio of the first-attempt success was 0.18 (95% CI: 0.11–0.30) for residents and 0.80 (95% CI: 0.51–1.24) for fellows. PTL was not independently associated with adjusted odds of TIAEs or severe oxygen desaturation. Conclusion: Higher PTL was associated with increased first-attempt success but not TIAE/oxygen desaturation. Identifying strategies to decrease adverse events during neonatal TI remains critical.

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Endoscopic Myotomy for Zenker’s Diverticulum (Z-POEM)

Gastrointestinal Interventional Endoscopy ◽

10.1007/978-3-030-21695-5_20 ◽

2019 ◽

pp. 283-290

Author(s):

Alessandro Fugazza ◽

Roberta Maselli ◽

Alessandro Repici

Keyword(s):

Zenker’S Diverticulum ◽

Zenker's Diverticulum ◽

Endoscopic Myotomy

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Usefulness of the Hook knife in flexible endoscopic myotomy for Zenker’s diverticulum

World Journal of Gastrointestinal Endoscopy ◽

10.4253/wjge.v9.i8.411 ◽

2017 ◽

Vol 9 (8) ◽

pp. 411 ◽

Cited By ~ 7

Author(s):

Olivier Rouquette ◽

Armando Abergel ◽

Aurélien Mulliez ◽

Laurent Poincloux

Keyword(s):

Zenker’S Diverticulum ◽

Zenker's Diverticulum ◽

Endoscopic Myotomy

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Successful single-session cricopharyngeal and Zenker’s diverticulum peroral endoscopic myotomy

Endoscopy ◽

10.1055/a-0624-1977 ◽

2018 ◽

Vol 50 (08) ◽

pp. E220-E221 ◽

Cited By ~ 5

Author(s):

Olaya Brewer Gutierrez ◽

Robert Moran ◽

Juliana Yang ◽

Omid Sanaei ◽

Anthony Kalloo ◽

...

Keyword(s):

Peroral Endoscopic Myotomy ◽

Zenker’S Diverticulum ◽

Single Session ◽

Zenker's Diverticulum ◽

Endoscopic Myotomy

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Comparison of the Efficacy, Safety and Tolerability of Azithromycin and Co-Amoxiclav in the Treatment of Acute Periapical Abscesses

Journal of International Medical Research ◽

10.1177/030006059802600506 ◽

1998 ◽

Vol 26 (5) ◽

pp. 257-265 ◽

Cited By ~ 15

Author(s):

CF Adriaenssen

Keyword(s):

Soft Tissue ◽

Adverse Events ◽

Comparative Study ◽

Clinical Success ◽

Point Scale ◽

Once Daily ◽

Significant Difference ◽

Before And After ◽

Dental Practices

The activity, safety and tolerability of the azalide azithromycin were compared with those of co-amoxiclav in the treatment of acute periapical abscesses in adults in an open, randomized, multicentre comparative study. Patients of either sex, recruited from 106 dental practices in Belgium, were aged between 18 and 75 years and had acute periapical abscesses not requiring drainage, confirmed by radiology. Azithromycin was administered as a 500-mg tablet orally once daily for 3 days ( n = 150) and co-amoxiclav as a 625-mg capsule three times daily, for 5–10 days ( n = 153). Both before and after treatment, masticatory pain, percussion pain, headache, and oedema and redness of soft tissue were graded on a four-point scale. Overall clinical success (cure plus improvement) was seen in 131/144 (91%) evaluable patients receiving azithromycin and in 142/148 (96%) receiving co-amoxiclav (difference not significant). There was no significant difference between the two groups in the incidence or severity of adverse events or in the number of discontinuations because of adverse events.

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