567 results on '"Zenker's diverticulum"'
Search Results
2. The safety and efficacy of endoscopic approaches for the management of Zenker's diverticulum: a multicentre retrospective study.
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Norton, Benjamin, Siggens, Katie, Papaefthymiou, Apostolis, Telese, Andrea, Duku, Margaret, Murino, Alberto, Johnson, Gavin, Murray, Charles, Mohammadi, Borzoueh, Mughal, Muntzer, Bisschops, Raf, Bhandari, Pradeep, Birchall, Martin, and Haidry, Rehan
- Abstract
Introduction: Minimally invasive endoscopic options are safe and effective alternatives to surgery for the treatment of symptomatic Zenker's diverticulum (ZD). However, there is no consensus on the gold-standard approach. We compared the safety and efficacy of Zenker's peroral endoscopic myotomy (Z-POEM), flexible diverticulotomy (FD), and rigid diverticulotomy (RD) for the management of ZD. Methods: Patients undergoing treatment for ZD at three UK tertiary referral centres were identified and analysed between 2013 and 2023. Patient demographics, procedural details, clinical success, and 30-day adverse events (AE) were recorded. The primary outcomes were technical and clinical success defined as a fall in Dakkak and Bennett dysphagia score to ≤ 1 without re-intervention. Results: There was no difference in baseline characteristics amongst 126 patients undergoing intervention (50 RD, 31 FD, 45 Z-POEM). Technical success for RD, FD, and Z-POEM was 80%, 100%, and 100%, respectively (p < 0.001). Over a mean follow-up of 11.0 months (95% CI 8.2–13.9), clinical success amongst those treated was 85.3% (RD), 74.1% (FD), and 83.7% (Z-POEM; p = 0.48) with recurrence in 17.2% (RD), 20.0% (FD), and 8.3% (Z-POEM; p = 0.50). AEs were equivalent between groups (p = 0.98). During this time, 11 patients underwent surgical myotomy with low clinical success (36.4%) and high morbidity. Conclusion: Endoscopic options for the treatment of ZD show equivalent rates of success, but failed RD often led to open myotomy with worse outcomes. Flexible endoscopic modalities are both safe and highly effective treatments that may be considered first-line in experienced centres and should be offered before surgery. [ABSTRACT FROM AUTHOR]
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- 2024
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3. Zenker's diverticulum: A case study of dysphagia in an elderly gentleman
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Prajwal Dahal, MD, Saurav Krishna Malla, MD, Rudra Prasad Upadhyaya, MD, Sabina Parajuli, MBBS, and Natasha Dhakal, MBBS
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Barium swallow ,Halitosis ,Killian dehiscence ,Pulsion ,Zenker's Diverticulum ,Medical physics. Medical radiology. Nuclear medicine ,R895-920 - Abstract
Zenker's diverticulum (ZD) is an acquired, false, and pulsion diverticulum formed by the protrusion of mucosa and submucosa through Killian's dehiscence. The index case is a 91-year-old Nepali patient with a known history of diabetes mellitus, hypertension, rheumatic heart disease, and stage 4 chronic kidney disease, who has been experiencing dysphagia, halitosis, and chronic cough for 25 years. A computed tomography (CT) scan of the chest revealed an outpouching filled with air, fluid, and some solid contents, arising at the level of the cricoid cartilage and extending posteriorly to the esophagus, compressing it. A barium swallow test was performed for confirmation and revealed similar findings. The patient was counseled for surgery but declined due to old age and comorbidities. ZD is commonly seen in the geriatric population and patients with neuromuscular discordance. Barium swallow and CT chest scans can diagnose ZD, and surgery is the mainstay of treatment.
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- 2024
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4. Flexible endoscopic treatment of Zenker’s diverticulum—a retrospective, observational multicenter study
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Steinbrück, Ingo, Rempel, Viktor, Kuellmer, Armin, Miedtke, Valentin, Faiss, Siegbert, von Hahn, Thomas, Pohl, Jürgen, Grothaus, Johannes, Friesicke, Matthias, Schmidt, Arthur, and Allgaier, Hans-Peter
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- 2024
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5. Effectiveness and safety of stag beetle knife (SB knife) in management of Zenker's diverticulum: a systematic review and meta-analysis.
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Dahiya, Dushyant Singh, Deliwala, Smit, Chandan, Saurabh, Ramai, Daryl, Ali, Hassam, Kassab, Lena L, Facciorusso, Antonio, and Kochhar, Gursimran S
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DIVERTICULUM , *BEETLES , *KNIVES , *DISEASE remission - Abstract
Stag Beetle Knife (SB Knife) is increasingly being utilized for Zenker's Diverticulectomy (ZD). Our study assessed the effectiveness and safety of the SB Knife for the management of ZD. Ovid EBM reviews, Ovid Embase, Ovid Medline, ClinicalTrials.gov , Scopus, and Web of Science were searched to identify studies that utilized SB knife for ZD. Pooled proportions (PP) were calculated using the random-effects model. Heterogeneity was evaluated using I2 statistics. A total of 7 studies with 268 patients were included in the final analysis. Dysphagia and regurgitation were the most common clinical symptoms. The mean size of the ZD was 2.8 ± 0.7 cm and 28 (of 148) patients had undergone previous treatments. The PP of technical success was 98% (95% CI: 92.3–99.5; I20) with a mean procedure duration of 26.2 ± 8.3 minutes. The PP of clinical response at first follow-up and relapse after index procedure was 87.9% (95% CI: 81.6–92.3; I219) and 13.5% (95% CI: 9.6–18.6; I22), respectively. At final follow-up, the PP of clinical remission was 96.2% (95% CI: 91–98.4; I230.6) while the PP of procedure failure was 3.6% (95% CI: 1.6–8.1; I20). No severe adverse events (AEs) were noted while using the SB Knife. However, the PP of intraprocedural and postprocedural AEs was 13.2% (95% CI: 9.6–17.8; I20) and 9.3% (95% CI: 5.7–14.9; I2 < 20.9), respectively. SB Knife is highly safe and effective for Zenker's Diverticulectomy with a failure rate of only 3.6%. [ABSTRACT FROM AUTHOR]
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- 2024
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6. A Multidisciplinary Minimally Invasive Approach Is Necessary for the Contemporary Management of Esophageal Diverticula.
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Broderick, Ryan C., Spurzem, Graham J., Huang, Estella Y., Sandler, Bryan J., Jacobsen, Garth R., Weisman, Robert A., Onaitis, Mark W., Weissbrod, Philip A., and Horgan, Santiago
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Background: Esophageal diverticula were traditionally treated with open surgery, which is associated with significant morbidity and mortality rates. Management has shifted to minimally invasive approaches with several advantages. We examine outcomes in patients with esophageal diverticula treated with minimally invasive techniques by a multidisciplinary surgical team at a single center. Materials and Methods: A retrospective review of a prospectively maintained database was performed for patients who underwent minimally invasive surgery for esophageal diverticula at our institution from June 2010 to December 2022. Primary outcomes were 30-day morbidity and mortality rates. Secondary outcomes were symptom resolution, length of stay (LOS), readmission, and need for reintervention. Results: A total of 28 patients were identified. Twelve patients had pharyngeal diverticula, 7 patients had midesophageal diverticula, and 9 patients had epiphrenic diverticula. Thirty-day morbidity and readmission rates were 10.7% (3 patients), 1 pharyngeal (sepsis), 1 midesophageal (refractory nausea), and 1 epiphrenic (poor oral intake). There were no esophageal leaks. Average LOS was 2.3 days, with the pharyngeal group experiencing a significantly shorter LOS (1.3 days versus 3.4 days for midesophageal, P < .01 versus 2.8 days for epiphrenic, P < .05). Symptom resolution after initial operation was 78.6%. Reintervention rate was 17.9%, and symptom resolution after reintervention was 100%. There were no mortalities. Conclusion: This study demonstrates that esophageal diverticula can be repaired safely and efficiently when performed by a multidisciplinary team utilizing advanced minimally invasive endoscopic and robotic surgical techniques. We advocate for the management of this rare condition at a high-volume center with extensive experience in foregut surgery. [ABSTRACT FROM AUTHOR]
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- 2024
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7. Endoluminal treatment for Zenker's diverticulum – a population-based observational study.
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Søfteland, Eirik Østensen, Aasebøstøl, Anne Kristin, Johnsen, Gjermund, and Bringeland, Erling Audun
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DIVERTICULUM , *NASAL surgery , *GASTROINTESTINAL surgery , *LASER surgery , *SCIENTIFIC observation , *EAR infections , *ENDOSCOPIC surgery , *POSTOPERATIVE nausea & vomiting - Abstract
Zenker's diverticulum is a false diverticulum arising in the oesophago-pharyngeal junction. It may cause symptoms like dysphagia and regurgitation. In Central Norway, treatment is centralized to St. Olavs hospital, either as an endoscopic stapled oesophago-diverticulostomy procedure at the Department of Gastrointestinal Surgery or as laser diverticulostomy at the Department of Ear, Nose and Throat Surgery, depending on diverticulum size. Retrospective, population-based, study from 2001–2020 on patients treated for Zenker's diverticulum, at the time with a rigid endoscopic approach. Patients were identified through the in-hospital register for operations. The two treatment groups were compared on relevant pre-, intra-, and postoperative variables by review of the individual patient records. 78 consecutive patients, 36 at Dept. of Ear, Nose and Throat Surgery and 42 at Dept. of Gastrointestinal Surgery, were treated with a total of 104 interventions. Crude incidence for a surgery-demanding Zenker's diverticulum was 0.57 per 100 000 per year. The Dept. of Ear, Nose and Throat Surgery administered significantly less often prophylactic antibiotics than the Dept. of Gastrointestinal Surgery (p < 0.001), administered more frequently intraoperative dexamethasone (p < 0.001), and had significantly more postoperative infections (19.6% vs 3.4%, p = 0.01). No procedure-related mortality was registered. Although no standardized follow-up took place, at a median of 119 months elapsed, observed clinical recurrence was 35% for the endostapler treatment and 51% for the laser treatment procedure. Both rigid endoscopic stapled oesophago-diverticulostomy and laser diverticulostomy are safe treatments for Zenker's diverticulum, however with a substantial risk of recurrence. [ABSTRACT FROM AUTHOR]
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- 2024
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8. Outcomes after per-oral endoscopic myotomy for Zenker's diverticula (Z-POEM) and correlation with impedance planimetry (FLIP).
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Che, Simon Y. W., Joseph, Stephanie, Kuchta, Kristine, Amundson, Julia R., VanDruff, Vanessa N., Ishii, Shun, Zimmermann, Christopher J., Hedberg, Herbert M., and Ujiki, Michael B.
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MYOTOMY , *DIVERTICULOSIS , *HEALTH outcome assessment - Abstract
Introduction: Zenker's diverticulum (ZD) is a false pulsion diverticulum of the cervical esophagus. It is typically found in older adults and manifests with dysphagia. The purpose of this study is to describe our experience with Per-oral endoscopic myotomy for Zenker's (Z-POEM) and intraoperative impedance planimetry (FLIP). Methods: We performed a single institution retrospective review of patients undergoing Z-POEM in a prospective database between 2014 and 2022. Upper esophageal sphincter (UES) distensibility index (DI, mm2/mmHg) was measured by FLIP before and after myotomy. The primary outcome was clinical success. Secondary outcomes included technical failure, adverse events, and quality of life as assessed by the gastroesophageal health-related quality of life (GERD-HRQL), reflux severity index (RSI), and dysphagia score. A statistical analysis of DI was done with the paired t-test (p < 0.05). Results: Fifty-four patients underwent Z-POEM, with FLIP measurements available in 30 cases. We achieved technical success and clinical success in 54/54 (100%) patients and 46/54 patients (85%), respectively. Three patients (6%) experienced contained leaks. Three patients were readmitted: one for aforementioned contained leak, one for dysphagia, and one post-operative pneumonia. Three patients with residual dysphagia underwent additional endoscopic procedures, all of whom had diverticula > 4 cm. Following myotomy, mean DI increased by 2.0 ± 1.7 mm2/mmHg (p < 0.001). In those with good clinical success, change in DI averaged + 1.6 ± 1.1 mm2/mmHg. Significant improvement was found in RSI and GERD-HRQL scores, but not dysphagia score. Conclusion: Z-POEM is a safe and feasible for treatment of ZD. We saw zero cases of intraoperative abandonment. We propose that large diverticula (> 4 cm) are a risk factor for poor outcomes and may require additional endoscopic procedures. An improvement in DI is expected after myotomy, however, the ideal range is still not known. [ABSTRACT FROM AUTHOR]
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- 2024
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9. Minimally Invasive Surgery of the Gastro-esophageal Junction (MISGEJ)
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- 2023
10. Per-oral endoscopic myotomy is a safe and effective treatment for Zenker's diverticulum: a retrospective multicenter study.
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Ward, Marc A, Fair, Lucas, Misenhimer, Jennifer, Esteva, Simón, Greenberg, Ian, Ogola, Gerald, Aladegbami, Bola, Leeds, Steven G, and Kedia, Prashant
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DIVERTICULUM , *MYOTOMY , *RETROSPECTIVE studies , *DATABASES - Abstract
Zenker per-oral endoscopic myotomy (ZPOEM) has become a promising technique for Zenker's diverticulum (ZD). The aim of this study was to add to the limited body of literature evaluating the safety and efficacy of ZPOEM. A prospectively maintained database was retrospectively reviewed to identify patients who underwent ZPOEM at two separate institutions between January 2020 and January 2022. Demographics, preoperative and postoperative clinical data, intraoperative data, adverse events, and length of stay were analyzed. A total of 40 patients (mean age 72.5 years, 62.5% male) were included. Average operative time was 54.7 minutes and average length of stay was 1.1 days. There were three adverse events, and only one was related to the technical aspects of the procedure. Patients showed improvement in the Functional Oral Intake Scale (FOIS) scores at 1 month (5 vs 7, p < 0.0001). The median FOIS scores remained 7 at both 6 and 12 months, although this improvement was not statistically significant at these time intervals (p = 0.46 and 0.37, respectively). Median dysphagia scores were decreased at 1 (2.5 vs 0, p < 0.0001), 6 (2.5 vs 0, p < 0.0001), and 12 months (2.5 vs 0, p = 0.016). The number of patients reporting ≥1 symptom was also decreased at 1 (40 vs 9, p < 0.0001) and 6 months (40 vs 1, p = 0.041). Although the number of patients reporting ≥1 symptom remained consistent at 12 months, this was not statistically significant (40 vs 1, p = 0.13). ZPOEM is a safe and highly effective treatment for the management of ZD. [ABSTRACT FROM AUTHOR]
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- 2023
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11. A case of esophageal cancer in a diverticulum treated by surgical resection: a case report.
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Fukuda, Momoko, Aoyama, Toru, Yukawa, Norio, Ju, Mihwa, Kano, Kazuki, Ishiguro, Tetsushi, Kazama, Keisuke, Sawazaki, Sho, Tamagawa, Hiroshi, Ikeda, Ryosuke, Kaneko, Hiroaki, Maeda, Shin, Saito, Aya, and Rino, Yasushi
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ESOPHAGEAL diverticula , *ESOPHAGEAL cancer , *MEDICAL research , *ENDOSCOPY , *GASTROINTESTINAL system - Abstract
Background: An esophageal diverticulum is a relatively rare disease, with reports of treatment for esophageal cancer in the diverticulum even rarer. Case presentation: The case involved a 72-year-old male with a chief complaint of dysphagia. He was diagnosed with an esophageal diverticulum (Zenker's diverticulum) measuring 10 cm in diameter. Five years later, an upper gastrointestinal endoscopy revealed an iodine-unstained 0–IIb lesion of 20 mm in diameter with type B1 vessels in the diverticulum. An endoscopic biopsy and CT revealed it to be squamous cell carcinoma, cT1a-EP/LPM N0 M0, cStage 0. Because the lesion was in the diverticulum and endoscopic resection was difficult with the risk of perforation, surgical resection was set as the course of treatment. Diverticulectomy was performed via a cervical approach, using a stapler, and the patient was discharged on the 16th day without any complications. The pathological diagnosis was pTis-EP, ly0, v0, R0. Conclusions: We think this case is very rare and diverticulectomy of early esophageal cancer in the diverticulum is available and safe. [ABSTRACT FROM AUTHOR]
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- 2023
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12. Objective Fluoroscopic Outcomes After Endoscopic Staple Versus Laser Zenker's Diverticulotomy.
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Zhao, Nina W., Stasyuk, Anastasiya, Hernandez, Brian O., Cates, Daniel J., Kuhn, Maggie A., and Belafsky, Peter C.
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Objective: Endoscopic Zenker's diverticulotomy (EZD) is typically performed via stapling (endoscopic staple diverticulotomy; ESD) or CO2 laser (endoscopic laser diverticulotomy; ELD). Conflicting reports exist on which approach provides optimal outcomes. This investigation compared objective fluoroscopic data between ESD and ELD. Methods: A retrospective review of all patients undergoing primary EZD at a tertiary center between January 1, 2014 and January 10, 2022 was performed. Patients undergoing ESD and ELD were matched by preoperative diverticulum size. Primary outcome measures were postoperative diverticulum size and change in diverticulum size from pre‐ to postoperative swallowing fluoroscopy. Secondary outcome measures were the Eating Assessment Tool (EAT‐10) score, penetration aspiration scale (PAS), pharyngeal constriction ratio (PCR), and pharyngoesophageal segment opening (PESo). Results: Thirteen matched pairs with complete fluoroscopic data were identified. The mean (±SD) age of the cohort was 74.0 (±8.5) years. There were no age or gender differences between groups (p > 0.05). The mean pre‐operative ZD size was 1.98 (±0.69) cm for ESD and 1.97 (±0.72) cm for ELD; the mean postoperative size was 0.84 (±0.62) cm for ESD and 0.34 (±0.27) cm for ELD (p < 0.05). Mean diverticulum size improved by 1.14 (±0.59) cm after ESD and 1.62 (±0.59) cm after ELD (p < 0.05). There were no significant differences in postoperative EAT‐10, PAS, PCR, or PESo between groups. Conclusion: The data suggest that endoscopic laser Zenker's diverticulotomy results in a greater improvement in diverticulum size than endoscopic staple diverticulotomy. The data did not suggest a difference in postoperative dysphagia symptom scores or other objective fluoroscopic parameters between staple and laser diverticulotomy. Level of Evidences: Level 3 Laryngoscope, 133:3057–3060, 2023 [ABSTRACT FROM AUTHOR]
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- 2023
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13. Giant Zenker's diverticulum with esophageal obstruction and severe aspiration pneumonia
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Olga S. Arisheva, Maria A. Karnaushkina, Anastasia D. Strutynskaya, Ammar Rakan Deia, and Aleksandra O. Sosnina
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pharyngoesophageal diverticulum ,zenker's diverticulum ,esophageal obstruction ,aspiration pneumonia ,infectious esophagitis ,Internal medicine ,RC31-1245 - Abstract
Pharyngoesophageal diverticulum, or Zenker's diverticulum (ZD), is a rare pathology. With small diverticula that do not cause inflammation in the esophagus, the patient may not have any complaints or may only have a slight cough. As food accumulates in the formed diverticulum, its size increases, which is often accompanied by inflammation of the esophageal wall, compression of nearby organs, development of aspiration pneumonia, and in some cases may lead to esophageal perforation or esophageal bleeding. These complications can be life-threatening, so early diagnosis of ZD is extremely important. The article describes a clinical case of an elderly man with a late diagnosis of pharyngoesophageal diverticulum, complicated by the development of aspiration pneumonia, cachexia, electrolyte disturbances and acute renal failure. The complexity of patient management and diagnosis was due to recurrent aspiration with the development of severe pneumonia and the complexity of endoscopic examination methods.
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- 2023
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14. Laryngopharyngeal Reflux Before and After Cricopharyngeal Myotomy
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David G. Lott, M.D., PI
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- 2022
15. Comparing Open Versus Rigid Endoscopic and Flexible Endoscopic Techniques for the Treatment of Zenker's Diverticulum.
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Wallerius, Katherine P., Bowen, Andrew J., O'Byrne, Thomas J., Aden, Aisha A., Peraza, Lazaro R., Xie, Katherine Z., Richards, Bradley A., El‐Badaoui, Joseph, Bayan, Semirra L., Wong Kee Song, Louis M., and Ekbom, Dale C.
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Objective: To describe the outcomes of patients undergoing open stapler versus transoral rigid and flexible endoscopic therapies for symptomatic Zenker's diverticulum. Study Design: Single institution retrospective review. Setting: Tertiary care academic hospital. Methods: We retrospectively evaluated the outcomes of 424 consecutive patients who underwent Zenker's diverticulotomy via an open stapler, rigid endoscopic CO2 laser, rigid endoscopic stapler, rigid endoscopic harmonic scalpel, or flexible endoscopic technique from January 2006 to December 2020. Results: A total of 424 patients (173 females, mean age 73.1 ± 11.2 years) from a single institution were included. A total of 142 patients (33%) underwent endoscopic laser treatment, 33 (8%) underwent endoscopic harmonic scalpel, 92 (22%) underwent endoscopic stapler, 70 (17%) underwent flexible endoscopic, and 87 (20%) underwent open stapler. All open and rigid endoscopic procedures and most of the flexible endoscopic procedures (65%) were performed under general anesthesia. The flexible endoscopic group had a higher percentage of procedure‐related perforation, defined as subcutaneous emphysema or contrast leak on imaging (14.3%). The recurrence rates were higher in the harmonic stapler, flexible endoscopic, and endoscopic stapler groups at 18.2%, 17.1%, and 17.4%, respectively, and lower in the open group (1.1%). Length of hospital stay and return to oral intake were similar among groups. Conclusion: The flexible endoscopic technique was associated with the highest rate of procedure‐related perforation, while the endoscopic stapler had the lowest number of procedural complications. Recurrence rates were higher among the harmonic stapler, flexible endoscopic, and endoscopic stapler groups and lower in the endoscopic laser and open groups. Prospective comparative studies with long‐term follow‐up are needed. [ABSTRACT FROM AUTHOR]
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- 2023
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16. Myasthenic crisis as an initial presentation of myasthenia gravis in an 81-year-old following endoscopic myotomy for Zenker's diverticulum.
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Tran, Daniel, Fair, Lucas, Baginski, Bryana, Aladegbami, Bola, Leeds, Steven, and Ward, Marc
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In this article, we present the case of a patient with previously undiagnosed myasthenia gravis who underwent an endoscopic procedure for Zenker's diverticulum. The patient was readmitted due to ongoing dysphagia and severe respiratory distress caused by myasthenic crisis. This case demonstrates that myasthenia gravis, although rare, can occur in elderly patients and present with other sequelae that may mask the underlying diagnosis. [ABSTRACT FROM AUTHOR]
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- 2023
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17. Comparison of open surgery and transoral approach in Zenker's diverticulum.
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Demir, Halit Batuhan, Girgin, Tolga, and Çetin, Bartu
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DIVERTICULUM , *ENDOSCOPIC surgery , *SURGICAL complications , *DEGLUTITION disorders , *PATIENT safety , *LENGTH of stay in hospitals - Abstract
Introduction: In the surgical treatment of Zenker's diverticulum, endoscopic methods applied under general anesthesia have been used frequently in recent years. Endoscopic methods have gained popularity due to the shorter operative time, shorter hospital stay and transition to oral feeding, and low complication rates in selected patients. In this article, in the surgical treatment of Zenker's diverticulum; the open surgical approach and the transoral endoscopic surgical technique were compared. Materials and Methods: The patients in the study were divided into two groups those who underwent open surgery and those who underwent stapled diverticulectomy. Demographic data (age and gender), pre-operative symptoms (vomiting, dysphagia, and regurgitation), presence of post-operative complications, duration of hospitalization, diverticulum size, and long-term recurrence status of all patients were included in the study. Results: A total of 12 patients were included in the study. Staple diverticulectomy was performed in six of 12 patients by open surgical technique and in the other six patients by endoscopic technique. The mean ages of the patients who underwent endoscopic and open surgical modalities were 69 (61-84) and 68 (53-81), respectively. Of the patients who underwent open surgery, five were male and one was female. Of the patients who underwent endoscopic stapler diverticulectomy, four were male and two were female. Of the patients in the group who underwent open surgery, one had preoperative vomiting, three had dysphagia, and two had regurgitation. Conclusion: We think that transoral diverticulotomy is an effective surgical option that can be safely performed in selected patients and can provide successful results at least in the early period. [ABSTRACT FROM AUTHOR]
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- 2023
18. Transoral septotomy with septum traction is an effective treatment for recurrent Zenker diverticulum.
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Salvador, Renato, Provenzano, Luca, Bonventre, Giulia, Cutrone, Cesare, Moletta, Lucia, Sari, Marianna, Costantini, Andrea, Forattini, Francesca, Vittori, Arianna, Valmasoni, Michele, Costantini, Mario, and Capovilla, Giovanni
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DIVERTICULUM , *ESOPHAGOGASTRIC junction , *ORTHOPEDIC traction - Abstract
Symptoms of Zenker diverticulum can recur whatever the type of primary treatment administered. A modified transoral stapler-assisted septotomy (TS) was introduced in clinical practice a few years ago to improve the results of this mini-invasive technique. The aim of this prospective, controlled study was to assess the outcome of TS in patients with recurrent Zenker diverticulum (RZD), as compared with patients with treatment-naïve Zenker diverticulum (NZD). Patients diagnosed with NZD or RZD, and treated with TS between 2015 and 2021 were compared. Symptoms were recorded and scored using a detailed questionnaire. Barium swallow and endoscopy were performed before and after the TS procedure. In sum, 89 patients were enrolled during the study period: 68 had NZD and 21 had RZD. The patients' demographic and clinical data were similar in the two groups. Three mucosal lesions were detected intra-operatively, and one came to light at post-operative radiological assessment in the NZD group. No mucosal lesions were detected in the RZD group. The median follow-up was 36 months (interquartile range 23–60). The treatment was successful in 97% NZD patients and 95% of RZD patients (P = 0.56). This is the first comparative study based on prospectively collected data to assess the outcome of TS in patients with RZD. Traction on the septum during the procedure proved effective in the treatment of RZD, achieving a success rate that was excellent, and comparable with the outcome in treating NZD. [ABSTRACT FROM AUTHOR]
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- 2023
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19. C-reactive protein as an early marker of postoperative leakage in patients after endoscopic laser assisted Zenker's diverticulotomy.
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Kana, Martin, Kalfert, David, Lukes, Petr, Zabrodsky, Michal, and Plzak, Jan
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C-reactive protein , *PREOPERATIVE risk factors , *LEAKAGE , *LASERS , *VIDEOFLUOROSCOPY , *LASIK - Abstract
Background and aim: Minimally invasive endoscopic techniques are the treatment of choice for Zenker's diverticulum (ZD). Our objective was to evaluate the results and efficacy of endoscopic and open approaches, to determine whether postoperative C-reactive protein (CRP) serum levels can be used as a marker to exclude the presence of esophageal leakage, and to identify risk factors for development of postoperative leakage and complications. Materials and methods: Patients who underwent transcervical myotomy and diverticulotomy (TMD) or endoscopic cricopharyngeal myotomy (ECM) with CO2 laser for ZD in years 2008–2021 at our department were included in this retrospective study. Results: Of the 101 patients enrolled, 83 patients underwent ECM and 18 TMD. The procedure time of the endoscopic technique was significantly shorter compared to that of transcervical method (p < 0.001). The median time to oral intake was 6 days for ECM and 10.5 days in the TMD group (p < 0.001). There was a 13% (n = 11) and 16.7% (n = 3) symptomatic recurrence rate and 3.6% (n = 3) and 16.7% (n = 3) major complications rate for ECM and TMD groups, respectively. The incidence of contrast leak (CL) evaluated by postoperative swallow study was 8.9% (9 from 83 patients in the ECM group only). In patients with CL, a significant increase in CRP levels on postoperative day (POD) 2 and 3 was detected when compared to patients without CL. Conclusions: Endoscopic diverticulotomy with CO2 laser represents a safe and efficient treatment of ZD. Elevation of postoperative CRP serum levels over 123.8 mg/L on POD2 and 98.8 mg/L on POD3 may indicate presence of an esophageal leakage. [ABSTRACT FROM AUTHOR]
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- 2023
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20. Iatrogenic oesophageal fistulas after neck region surgery.
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Kowalik, Krzysztof, Gruszczyńska, Anna, Kowalska, Agnieszka, Pękala, Marek, and Modrzejewski, Andrzej
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ESOPHAGEAL fistula ,SURGICAL complications ,ESOPHAGEAL perforation ,POLISH literature ,IATROGENIC diseases - Abstract
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- 2023
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21. The impact of prior endoscopic or surgical therapy on open Zenker's diverticulum surgery: analysis on a large single center cohort: Comparison of primary and revisional open surgery for Zenker's diverticulum.
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Dimpel, Rebekka, Jell, Alissa, Reim, Daniel, Berlet, Maximilian, Kranzfelder, Michael, Vogel, Thomas, Friess, Helmut, Feussner, Hubertus, and Wilhelm, Dirk
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DIVERTICULUM , *PREOPERATIVE risk factors , *SURGICAL complications , *SURGERY , *UNIVARIATE analysis - Abstract
Background: Endoscopic treatment of Zenker's diverticulum is an attractive minimally invasive alternative compared to the classic open approach. However, increased recurrence rate were reported. In case of relapse, endoscopic therapy might be repeated, or alternatively open surgery is performed. This study aimed to identify potential differences in the outcomes between primary or secondary surgical treatment in Zenker's diverticulum. Methods: From January 2003 to April 2019, 227 subsequent patients underwent surgical diverticulectomy and cervical myotomy at the surgical department of TUM. 41 of 227 patients had received previous therapy, either open or endoscopic. Perioperative parameters in priorly untreated patients were retrospectively compared to those after previous therapy (mostly endoscopic) with special regard to perioperative data and postoperative complications. Univariate and multivariate regression analyses were performed to identify predictors for postoperative complications. Results: We could show that the number of complications (p = 0.047) in pretreated patients is significant higher as well as the severity after Clavien–Dindo (p = 0.025). Stapler line leakage, wound infections, and operative revision rate was higher also pretreated group. Pretreatment and surgery time showed a significant association with postoperative complications in univariate analysis. In multivariate analysis, pretreatment remained a significant independent predictor of complications. Conclusion: The present data indicate that endoscopic therapy might represent a risk factor for postoperative complications in case of relapse surgery. Therefore primary open surgery should be debated in patients with an increased high risk of relapse. [ABSTRACT FROM AUTHOR]
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- 2023
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22. Management of Esophageal Diverticula.
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Kamboj, Amrit K. and Law, Ryan J.
- Abstract
Purpose of review: Esophageal diverticula are outpouchings of the esophageal mucosa that are an uncommon but well-established cause of dysphagia. The purpose of this review is to highlight the endoscopic and surgical management of the various subtypes of esophageal diverticula. Current findings: Both surgical and endoscopic management options exist for the various esophageal diverticula subtypes, including Zenker's diverticulum, Killian–Jamieson diverticulum, mid-esophageal diverticulum, and epiphrenic diverticulum. These treatment options should be considered for patients with symptomatic esophageal diverticula, while asymptomatic patients can be observed without need for intervention. Submucosal myotomy of the muscular septum is a newer promising technique for management of esophageal diverticula that merits further study. Summary: Surgical and endoscopic management of various esophageal diverticula appears to be safe and feasible.The literature on both surgical and endoscopic approaches appears most robust for Zenker's diverticula and is more limited for the other esophageal diverticula given their rarity. [ABSTRACT FROM AUTHOR]
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- 2023
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23. Peroral cricopharyngeal myotomy for the management of Zenker's diverticulum in the hands of a general surgeon.
- Author
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Kelley, Jesse K., Haggerty, Diana K., Zambito, Giuseppe M., and Banks-Venegoni, Amy L.
- Subjects
- *
DIVERTICULUM , *ENDOSCOPIC surgery , *MYOTOMY , *TRAINING of surgeons , *LENGTH of stay in hospitals , *TREATMENT effectiveness - Abstract
Background: The treatment of Zenker's diverticulum has been shifted from open cricopharyngeal myotomy and rigid endoscopy to the use of flexible endoscopy. Few studies evaluate general surgeon's performance of flexible endoscopic management of Zenker's diverticulum as the majority are performed by gastroenterologists. The objective of our case series is to show that general surgeons trained in surgical endoscopy can perform this procedure with favorable outcomes. Methods: A retrospective review of peroral cricopharyngeal myotomies performed at Spectrum Health hospital in Grand Rapids, Michigan by a single surgical endoscopist between the 2018 and 2021 was conducted. The primary outcome was the improvement of dysphagia. Intra-procedural complications, post-procedural complications, hospital length of stay, time to oral intake, and recurrence were also evaluated. Age, sex, body mass index, diverticulum size, and procedure time were abstracted. Median (ranges) and frequencies (percentages) are used to describe the patient population and outcomes. Results: Forty patients were included in the study. Median age was 74 years old (60–95) with a male predominance (n = 27, 67.5%). Median BMI was 28 kg/m2 (18–43), average procedure length of 64 min (41–119), diverticulum size of 28 mm (19–90), and average length of stay of 0.9 days (0–8). There were no intra-procedural complications. All patients had a post-procedural esophagram prior to initiation of diet. Esophageal leak was the only complication that occurred, which was found on post-procedural esophagram (n = 5). Only two patients had clinical sequelae. All leaks closed without additional surgical intervention. The majority of patients had their diet resumed and discharged the same day of the procedure. Frequency of recurrence was 17.5% (n = 7). Conclusion: Our study demonstrates that general surgeons trained in endoscopy can perform endoscopic myotomies for Zenker's diverticula on a wide range of sizes, with favorable patient outcomes, and few complications. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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24. Pharyngoesophageal diverticulum mimicking thyroid nodules: Some interesting ultrasonographic signs
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Zhiqun Bai, Xuemei Wang, and Zhen Zhang
- Subjects
pharyngoesophageal diverticulum ,Zenker’s diverticulum ,Killian–Jamieson diverticulum ,thyroid nodules ,ultrasonographic features ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
ObjectiveTo analyze the ultrasonographic features of pharyngoesophageal diverticulum (PED) mimicking thyroid nodules and to explore the clinical value of ultrasonography in the diagnosis of PED.MethodThe sonographic findings of 68 patients with PED were retrospectively reviewed. According to the diverticulum echo intensity characteristics, the lesions were divided into solid nodular diverticulum, gas-containing nodular diverticulum, liquid-containing nodular diverticulum, and atypical diverticular changes; and the ultrasonographic manifestations were compared among the four groups.Results30/68 were solid nodular diverticula. The diverticulum cavity was oval or elliptic with a clear border, and the diverticulum wall suggested exhibited a typical hyper-hypo-hyper-echogenic pattern. The diverticulum wall and esophageal wall were seen to be continuous if multiple sections were scanned, and hypoechoic walls showed punctate blood flow. 29/68 diagnosed with air-containing nodular diverticulum, lesions appeared with gas-like hyper-echogenicity internally, with some amount of gas and change in the tail pattern during swallowing. 6/68 patients were diagnosed with liquid-containing nodular diverticulum, and the main ultrasonic manifestations were an anechoic internal diverticulum cavity that was clearly bounded from the thyroid but continuous with the esophageal wall, with a typical hyper-hypo-echoless pattern from the outside to the inside. Another 3/68 were found to have atypical diverticular changes, regional convexities of the esophageal wall with unfashioned nodules. The convex segment was continuous with the hyper-hypo-echogenic esophageal wall and could be seen on slitting scanning.ConclusionOverall, PEDs mimicking thyroid nodules have specific ultrasonographic features. Familiarity with them can avoid missed diagnoses and misdiagnoses.
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- 2023
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25. Flexible endoscopic incisional therapy for Zenker's diverticulum (FEIT-Z) is an effective treatment for surgical failures or non-operative patients.
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Diehl, David L., Mehta, Minesh J., Khalid, Ammara, Shafqet, Muhammad A., Khara, Harshit S., and Confer, Bradley
- Abstract
Background: Symptomatic Zenker's diverticulum (ZD) occurs mostly in the elderly, who often have significant comorbidities, and poor neck hyperextension, putting them at high risk for surgical management while also increasing the potential of technical failure. Flexible endoscopic incisional therapy for Zenker's diverticulum (FEIT-Z) offers a safe approach to this problem with high technical and clinical success rates. There are limited data on its use following a failed surgical approach or in patients unfit for a surgical approach. The aim of this study was to assess clinical and technical outcomes of FEIT-Z in patients who were non-operative candidates or refused or failed surgical management. Methods: Patients who underwent FEIT-Z from January 2015 to February 2019 at a tertiary referral center were included. Patient demographics, prior ZD surgical history, procedural data, dysphagia scores, clinical success, and adverse events (AE) were collected. Univariable analysis was performed to assess differences between pre- and post-FEIT-Z dysphagia scores. Results: 30 patients undergoing FEIT-Z were included. Seven had a prior failed ZD surgical approach, 6 refused surgical management, and 17 were deemed to be non-operative candidates based on medical comorbidities. Mean age was 78.4 (± 12.1) and 36.7% were male. Technical success of FEIT-Z was 96.7%. There was a significant improvement in dysphagia scores after FEIT-Z: 2.3 (± 0.64) vs. before, 0.4 (± 0.76) (p < 0.001). Long-term clinical success was achieved in 73.3% of patients. Adverse events were seen in 23.3% of patients; however, these were graded as mild in 85.7% of patients. One microperforation was managed with antibiotics. Conclusion: FEIT-Z is a safe procedure with low adverse events and a high rate of technical and clinical success. FEIT-Z can be done in patients who fail previous surgical treatment, refuse a surgical approach, or are not surgical candidates due to medical comorbidity or other factors. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
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26. Zenker's Diverticulum: Readability and Quality of Online Written Education Materials.
- Author
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Shneyderman, Matthew, Davis, Ruth, Snow, Grace, Dhar, Shumon, and Akst, Lee M.
- Abstract
To assess the readability and quality of online materials for Zenker's diverticulum. A Google search of "Zenker's diverticulum" was performed and the first 50 websites were reviewed. Readability was measured by Flesch Reading Ease (FRES), Flesch-Kincaid Grade Level (FKGL) and the Simple Measure of Gobbledygook (SMOG) scores using an online calculator. Understandability and actionability were assessed with the Patient Education Materials Assessment Tool for Printed Materials (PEMAT-P). Websites were categorized as either patient-targeted or physician-targeted and unpaired t tests were used to compare scores between these two groups. A total of 31 websites (23 patient-oriented sites and 8 physician-oriented sites) were analyzed. The average FRES, FKGL, and SMOG scores were 29.96 ± 14.72, 13.75 ± 2.78, and 12.19 ± 2.02, respectively, for the entire cohort. Readability scores for the patient-oriented sites were better than the physician-oriented sites for each measure (FRES 36.21 ± 8.86 vs 11.96 ± 13.54, FKGL 12.68 ± 1.58 vs 16.85 ± 3.25, and SMOG 11.37 ± 1.26 vs 14.53 ± 1.98; p < 0.001 for all comparisons). PEMAT-P understandability and actionability scores for the entire cohort were 68.20% ± 10.19% and 10.75% ± 16.52% respectively, and did not differ between patient-oriented and physician oriented sites. Though patient-oriented sites had better readability than physician-oriented sites for Zenker's Diverticulum, both categories had readability levels more advanced than what is recommended for medical education materials. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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27. Zenker’s Diverticulum in Forestier Disease: Chance or Causality?
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Carmelo Saraniti, Giuseppe Greco, Barbara Verro, Enzo Chianetta, and Antonio Lo Casto
- Subjects
diffuse idiopathic skeletal hyperostosis ,dysphagia ,zenker’s diverticulum ,esophageal diverticulum ,forestier disease ,Otorhinolaryngology ,RF1-547 - Abstract
Introduction:Zenker's diverticulum is an acquired sac-like outpouching of the mucosa and submucosa layers originating at the pharyngoesophageal junction. The predominant symptom of Zenker’s diverticulum is dysphagia. Videofluoroscopy confirms the diagnosis. Forestier disease is a clinical entity characterized by ossification of anterolateral vertebral ligament and anterior osteophyte formation along the anterolateral spinal column. Its etiopathogenesis remains unknown and common symptoms are dysphagia, dysphonia and airway obstruction. The objective of this study is to identify a pathophysiological correlation between Forestier disease and the onset of Zenker’s diverticulum. Materials and Methods:A retrospective observational study was conducted. The electronic database of our Radiology Unit was analyzed in order to identify patients with hypopharyngeal diverticulum and osteophytes at the cervical vertebrae level, from January 2010 to January 2021. The search was performed using precise keywords. Results:The computerized database search outlined 10 imaging exams: 5 videofluorographies and 5 computed tomography scans. In 100% of the cases, dysphagia was the main symptom that led to the diagnostic assessment; 30% of patients, on the other hand, reported dyspnoea. From the data analysis, the male / female ratio is 1: 1 and the average age of the patients is 64.8 (+/- 11.31) years. Conclusions:We assume that the anatomical abnormalities in Forestier disease may cause an increase of pharyngeal pressure and consequently support the development of the Zenker’s diverticulum. Hence, it is always recommended to investigate the presence of Zenker’s diverticulum in a patient with Forestier disease, especially for the life-threatening complications of Zenker’s diverticulum.
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- 2022
- Full Text
- View/download PDF
28. Rare Causes of Unilateral Vocal Fold Paralysis: Report of 3 Cases with Review of Literature.
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Dhingra, Shruti, Juneja, Ruchika, Kazi, Farha N., and Nerurkar, Nupur
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- *
VOCAL cords , *FOREIGN bodies , *PARALYSIS , *LITERATURE reviews , *DIVERTICULUM , *LYMPH nodes - Abstract
Unilateral vocal fold paralysis is a common finding with a variety of underlying causes. The six main etiologic groups include neoplastic, traumatic (iatrogenic, accidental) neurological, inflammatory, congenital, and idiopathic. Various unusual causes have been described including foreign body ingestion, mediastinal lymph nodes, large pleural blebs, tracheal diverticulum, etc. It is therefore essential, that a thorough evaluation and methodical approach be undertaken to ascertain the etiology, before labelling it as idiopathic and offering any treatment. This review article focuses on the uncommon and rare causes of unilateral vocal fold paralysis that are presented through 3 representative case reports; a cardio-vocal (Ortner's) syndrome, Zenker's diverticulum and diffuse idiopathic skeletal hyperostosis. These examples are discussed with radiological findings in the context of current literature. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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29. Natural History of Cricopharyngeus Muscle Dysfunction Symptomatology.
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Randall, Derrick R., Chan, Ryan, Gomes, Dayani, and Walker, Kim
- Abstract
Cricopharyngeus muscle dysfunction (CPMD) is a common cause for progressive dysphagia and can lead to dietary restriction, reduced nutrition, weight loss, and pneumonia. There is a continuum between small, non-obstructive cricopharyngeus bars representing mild disease and severely obstructive bars or Zenker's diverticulum forming late-stage disease, but the natural history of untreated CPMD and the associated time course for progression is unknown. Retrospective longitudinal cohort study from a tertiary outpatient dysphagia centre. Patients diagnosed with CPMD by fluoroscopy and either awaiting surgical treatment or electing non-operative management were evaluated through prospectively collected Eating Assessment Tool-10 (EAT-10) and Functional Oral Intake Scale (FOIS). Review of available imaging identified degree of CPMD. We identified 174 patients with CPMD diagnosed between July 1, 2016, and June 30, 2020; 52 patients had serial Eating Assessment Tool (EAT-10) measures obtained at time of diagnosis and follow up appointment without operative treatment. Mean EAT-10 scores increased from 17.1 to 20.6 (3.5 ± 8.1 points, p = 0.002) points. This change was related to those with a Zenker's diverticulum rather than an isolated cricopharyngeus bar. Dietary outcomes measured by FOIS were stable. While some patients showed fluoroscopic progression of bar size, no patients developed a Zenker's diverticulum from a pre-existing bar in this population. Our data indicate patients with a cricopharyngeus bar do not decline in subjective dysphagia score or diet tolerance, however those with a Zenker's diverticulum worsen over time. This has implications for treatment timing and counselling patients but also reflects a need to understand the pathophysiology behind CPMD and the subset of patients who show progression. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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30. Congenital and Iatrogenic Esophageal Diverticula in Infants and Children: A Case Series of Four Patients.
- Author
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Garcia DJ, Nashwan AJ, and Al-Ansari AN
- Abstract
In pediatric patients, esophageal diverticulum (ED) is rare and can be severe, especially when involving the cervical esophagus. Diagnosis and treatment typically start after birth, with some cases managed conservatively. This series presents four ED cases from Jose Marti y Perez Pediatric Teaching Hospital in Cuba (2003-2020). Symptoms included difficulty swallowing, regurgitation, and breathing problems. Three cases required surgery: a five-month-old post-esophageal-coloplasty (managed conservatively), a four-year-old post-esophageal atresia repair (diverticulum partially used to fix a narrow spot), and a 16-year-old with Zenker's diverticulum (requiring surgical removal). A 35-day-old baby with ED post-type C esophageal atresia surgery died from a pre-existing condition. Surviving patients lived healthy lives. ED in pediatrics can be congenital or iatrogenic post-esophageal repair. Reflux symptoms, respiratory distress, or a cervical mass should prompt suspicion of ED., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Garcia et al.)
- Published
- 2024
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31. Tunnel-free peroral endoscopic myotomy reduces procedural time and maintains efficacy in Zenker's diverticulum.
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Mavrogenis G, Zachou M, Tsevgas I, Markoglou K, Zachariadis D, Spanomanoli A, Chatzis M, and Bazerbachi F
- Abstract
Background: Peroral endoscopic myotomy (Z-POEM) is an effective treatment for Zenker's diverticulum (ZD), but procedural time and safety vary based on technique. Modified Z-POEM approaches incorporating fewer submucosal tunnels may offer advantages., Methods: In this retrospective, single-center study, we compared outcomes among 20 patients with ZD undergoing standard Z-POEM (2 tunnels), single-tunnel Z-POEM (ST Z-POEM), or tunnel-free Z-POEM (TF Z-POEM). All procedures included mucosotomy over the septum and deep extension of myotomy into the esophagus (2 cm). Primary endpoints were procedural time, clinical success, and adverse events., Results: Patients had a mean age of 67.3±12.2 years, and 70% presented with respiratory symptoms. Mean procedure times were 45 min (standard Z-POEM), 33 min (ST Z-POEM), and 30 min (TF Z-POEM), with a statistically significant difference between the standard and TF Z-POEM groups (P=0.014). Technical success was 100%, and the mean hospital stay was 1.3±1.3 days. One adverse event (5%) occurred. Clinical success, defined as improvement in dysphagia score (3 to 0.05, P<0.001) and resolution of respiratory symptoms, was achieved in all patients., Conclusions: In this study, modified Z-POEM techniques utilizing single-tunnel or tunnel-free approaches, combined with over-the-septum mucosotomy and deep esophageal myotomy (2 cm), demonstrated feasibility, safety and a significantly shorter procedural time compared to standard Z-POEM. These findings suggest potential benefits for ZD treatment, warranting further investigation in larger prospective studies., Competing Interests: Conflict of Interest: None, (Copyright: © 2024 Hellenic Society of Gastroenterology.)
- Published
- 2024
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32. Comparative analysis of CO2 laser and ultracision harmonic scalpel for endoscopic treatment of Zenker's diverticulum using a propensity score: A retrospective observational study.
- Author
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Maquet C, Evrard M, Laffouilhere TP, Lacassin M, Nokovitch L, Marie JP, Slama NB, Crampon F, and Deneuve S
- Abstract
Objectives: Zenker's diverticulum (ZD) is a progressive condition that can cause dysphagia and aspiration. Endoscopic cricopharyngeal myotomy (ECPM) is the gold standard treatment for ZD, but there are various techniques available. We aimed to compare the efficacy and safety of the ultrasonic harmonic scalpel (UHS) versus the CO2 laser (CO2L) for ECPM in ZD., Design: We led an observational study. The main composite outcome consisted in persistence of postoperative dysphagia OR recurrence/reoperation of symptomatic ZD within two years postoperatively. Surgery was considered effective when no dysphagia within two years postoperatively. The secondary outcome was the occurrence of acute mediastinitis within 72 h postoperatively. A propensity score was built to adjust for differences observed between non-randomized groups. Additional sensitivity analyses were performed., Setting: All patients with ECPM surgery for ZD were included from 2011 to 2018 in a single tertiary center. Patients with failure of endoscopic exposition were excluded., Participants: The study included 86 patients who underwent ECPM with either the CO2L (n = 53) or UHS (n = 33) technique. ZD size and other demographic variables were comparable between the groups., Main Outcome Measures: UHS had superior efficacy compared to CO2L (relative risk of failure = 0.29; 95 % confidence interval: 0.05-1.0; p = 0.05), but there was a higher incidence of mediastinitis in the UHS group (12 % vs. 4 %), although this was not statistically significant., Results and Conclusion: The UHS technique appears to be an effective technique for ECPM in ZD patients but its safety remains to explore by further larger studies., (Copyright © 2024. Published by Elsevier Inc.)
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- 2024
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33. Third-Space Endoscopy: Recent Updates
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Zaheer Nabi and D Nageshwar Reddy
- Subjects
submucosal endoscopy ,achalasia ,gastroparesis ,zenker’s diverticulum ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Third space or submucosal space is a potential space which on expansion allows the endoscopist to execute a multitude of therapeutic procedures for various gastrointestinal diseases like achalasia, subepithelial tumors, Zenker’s diverticulum, and refractory gastroparesis. Third space was first utilized for performing endoscopic myotomy in cases with achalasia cardia about a decade ago. Since then, the field of submucosal endoscopy has witnessed an exponential growth. The present review focuses on recent advances in the field of third-space endoscopy. With regard to per-oral endoscopic myotomy (POEM) in achalasia cardia, several recent studies have evaluated the long-term outcomes of POEM, compared endoscopic myotomy with pneumatic dilatation (PD) and surgical myotomy, and evaluated the outcomes of short- versus long-esophageal myotomy. In addition, the utility of multiple dose antibiotic prophylaxis to prevent infections after POEM has been questioned. Overall, the results from these studies indicate that POEM is a durable treatment modality, equally effective to Heller’s myotomy and superior to PD. With regard to gastric-POEM (G-POEM), recent studies suggest only modest efficacy in cases with refractory gastroparesis. Therefore, quality studies are required to identify predictors of response to optimize the outcomes of G-POEM in these cases. Another third-space endoscopy procedure that has gained popularity is endoscopic division of septum in cases with esophageal diverticula including Zenker’s POEM and epiphrenic diverticula POEM (Z-POEM and D-POEM, respectively). The technique of diverticulotomy using the principles of submucosal endoscopy appears safe and effective in short term. Data on term outcomes are awaited and comparative trials with flexible endoscopic myotomy required. Per-rectal endoscopic myotomy (PREM) is the most recent addition to third space endoscopy procedures for the management of short-segment Hirschsprung’s disease. Limited data suggest that PREM may be a promising alternative surgery in these cases. However, quality studies with long-term follow-up are required to validate the outcomes of PREM.
- Published
- 2021
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34. POEM, GPOEM, and ZPOEM.
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Parsa, Nasim, Friedel, David, and Stavropoulos, Stavros N.
- Abstract
Our tripartite narrative review discusses Peroral Endoscopic Myotomy (POEM), gastric POEM (GPOEM) and POEM for Zenker's diverticula (ZPOEM). POEM is the prototypical procedure that launched the novel "3rd space endoscopy" field of advanced endoscopy. It revolutionized achalasia therapy by offering a much less invasive version of the prior gold standard, the laparoscopic Heller myotomy (HM). We review in detail indications, outcomes, technique variations and comparative data between POEM and HM particularly with regard to the hotly debated issue of GERD. We then proceed to discuss two less illustrious but nevertheless important offshoots of the iconic POEM procedure: GPOEM for gastroparesis and ZPOEM for the treatment of hypopharyngeal diverticula. For GPOEM, we discuss the rationale of pylorus-directed therapies, briefly touch on GPOEM technique variations and then focus on the importance of proper patient selection and emerging data in this area. On the third and final part of our review, we discuss ZPOEM and expound on technique variations including our "ultra-short tunnel technique". Our review emphasizes that, despite the superiority of endoscopy over surgery for the treatment of hypopharyngeal diverticula, there is no clear evidence yet of the superiority of the newfangled ZPOEM technique compared to the conventional endoscopic myotomy technique practiced for over two decades prior to the advent of ZPOEM. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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35. Cost-Effectiveness of Open vs. Endoscopic Repair of Zenker's Diverticulum.
- Author
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Lee, Paul B., Hojjat, Houmehr, Lucas, Jordyn, Chung, Michael T., Spillinger, Aviv, Meleca, Joseph B., Svider, Peter, Shkoukani, Mahdi, Johnson, Andrew, and Folbe, Adam
- Subjects
- *
ESOPHAGEAL diverticula , *DECISION trees , *STATISTICS , *CONFIDENCE intervals , *PATIENT decision making , *ESOPHAGEAL perforation , *DIGESTIVE system endoscopic surgery , *SURGICAL complications , *MEDICAL care costs , *TREATMENT effectiveness , *COST effectiveness , *COST analysis , *REOPERATION , *DESCRIPTIVE statistics , *SENSITIVITY & specificity (Statistics) , *ODDS ratio , *PROBABILITY theory - Abstract
Objective: To evaluate the cost-effectiveness of open versus endoscopic surgical repair of Zenker's diverticulum. Methods: In this study, an economic decision tree was utilized to compare the cost-effectiveness of open surgery compared to endoscopic surgery. The primary outcome in this analysis was the incremental cost-effectiveness ratio (ICER) that was calculated based on the economic decision tree. The probability of post-operative esophageal perforation complications, revision rates, and effectiveness of each procedure along with associated costs were extracted to construct the decision tree. Univariate sensitivity analysis was then utilized to determine how changes in esophageal perforation rate affect the cost-effectiveness of each surgical approach. Results: The ICER of open surgery for Zenker's diverticulum was $67 877, above most acceptable willingness to pay (WTP) thresholds. Additionally, if the probability of esophageal perforation with endoscopic surgery is above 5%, then open surgery becomes a more cost-effective option. Probabilistic sensitivity analysis using Monte Carlo simulations also showed that at the WTP thresholds of $30 000 and $50 000, endoscopic surgery is the most cost-effective method with 83.9% and 67.6% certainty, respectively. Conclusion: Open surgery and endoscopic surgery are 2 treatment strategies for Zenker's diverticulum that each have their own advantages and disadvantages that can complicate the decision-making process. With no previous cost-effectiveness analysis of open versus endoscopic surgery for Zenker's diverticulum, our results support the endoscopic approach at most common WTP thresholds. Particularly with the current focus on rising healthcare costs, our results can serve as an important adjunct to medical decision-making for patients undergoing treatment for Zenker's diverticulum. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
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36. Zenker's Diverticulum in Forestier Disease: Chance or Causality?
- Author
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Saraniti, Carmelo, Greco, Giuseppe, Verro, Barbara, Chianetta, Enzo, and Lo Casto, Antonio
- Subjects
- *
DIVERTICULUM , *MECKEL diverticulum , *SPINE , *CERVICAL vertebrae , *BONE spurs , *COMPUTED tomography , *VIDEOFLUOROSCOPY - Abstract
Introduction: Zenker's diverticulum is an acquired sac-like outpouching of the mucosa and submucosa layers originating at the pharyngoesophageal junction. The predominant symptom of Zenker's diverticulum is dysphagia. Videofluoroscopy confirms the diagnosis. Forestier disease is a clinical entity characterized by ossification of anterolateral vertebral ligament and anterior osteophyte formation along the anterolateral spinal column. Its etiopathogenesis remains unknown and common symptoms are dysphagia, dysphonia and airway obstruction. The objective of this study is to identify a pathophysiological correlation between Forestier disease and the onset of Zenker's diverticulum. Materials and Methods: A retrospective observational study was conducted. The electronic database of our Radiology Unit was analyzed in order to identify patients with hypopharyngeal diverticulum and osteophytes at the cervical vertebrae level, from January 2010 to January 2021. The search was performed using precise keywords. Results: The computerized database search outlined 10 imaging exams: 5 videofluorographies and 5 computed tomography scans. In 100% of the cases, dysphagia was the main symptom that led to the diagnostic assessment; 30% of patients, on the other hand, reported dyspnoea. From the data analysis, the male / female ratio is 1: 1 and the average age of the patients is 64.8 (+/- 11.31) years. Conclusions: We assume that the anatomical abnormalities in Forestier disease may cause an increase of pharyngeal pressure and consequently support the development of the Zenker's diverticulum. Hence, it is always recommended to investigate the presence of Zenker's diverticulum in a patient with Forestier disease, especially for the lifethreatening complications of Zenker's diverticulum. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
37. Anesthetic Management for Patient with Zenker's Diverticulum.
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Dilgard, John
- Published
- 2022
38. Transoral Laser-Assisted Diverticulectomy: Swallow Study Results after Complete Endoscopic Pouch Excision for Zenker's Diverticulum.
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McMillan, Ryan A., Bowen, Andrew J., Wells, Michael L., and Ekbom, Dale C.
- Subjects
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ESOPHAGEAL diverticula , *SURGICAL flaps , *MEDICAL lasers , *RETROSPECTIVE studies , *TERTIARY care , *FISHER exact test , *SURGICAL complications , *FLUOROSCOPY , *DISEASE relapse , *T-test (Statistics) , *ENDOSCOPIC gastrointestinal surgery , *COMORBIDITY - Abstract
Objective: Transoral endoscopic laser-assisted diverticulotomy (TELD) with diverticulectomy and diverticuloplasty (TELD + DD) for the management of Zenker's diverticulum (ZD) has been utilized by our institution since 2016 in attempts to reduce residual pouch size. This technique involves complete endoscopic pouch excision with partial advancement of mucosal flaps. Our study compares the subjective outcomes, objective outcomes, and complication rates between TELD and TELD + DD. Methods: A retrospective cohort study was performed on patients who underwent TELD or TELD + DD by a single surgeon at a tertiary academic center (2013-2019). Videofluoroscopic swallow studies (VFSS) with esophagram, Eating Assessment Tool (EAT-10), Reflux Symptom Index (RSI), and Functional Outcome Swallowing Scale (FOSS) were collected at preoperative and 3 month follow-up visits. A single blinded reviewer recorded height, width, and depth of pre and postoperative pouches with volumetric analysis performed assuming an ellipsoid shape. Comorbidities, complications, postoperative course, and recurrence were recorded. Results: Of the 75 patients that met criteria, 27 underwent TELD + DD and 48 underwent TELD. Eighteen TELD + DD and 37 TELD had both pre and post-operative VFSS. TELD + DD and TELD had a 96 ± 7% and 87 ± 16% reduction in pouch volume, respectively (t -test; P =.01). Complications (TELD + DD 7%, TELD 17%, fisher's exact; P =.31) and final subjective outcomes after adjusting for initial were not significantly different between methods (EAT-10 with TELD + DD ∆ + 1.3, P =.18; RSI ∆ + 1.4, P =.29; FOSS ∆-0.02, P =.91). One short-term recurrence was reported with TELD. Conclusion: Use of TELD + DD is associated with a statistically significantly decreased residual pouch size with no significant difference in short-term subjective outcomes. Complication rates and short-term recurrence rates are comparable. Long-term recurrence rates will require further studies to characterize. Level of Evidence: Level 3. [ABSTRACT FROM AUTHOR]
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- 2022
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39. Assessing the Clinical Utility of the Early Postoperative Pharyngogram in Hypopharyngeal Surgery for Dysphagia.
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Gobillot, Theodore A., Garber, David, Merati, Albert L., and Wandell, Grace M.
- Abstract
Objectives/Hypothesis: To evaluate the clinical utility of postoperative contrast x‐ray pharyngograms (XRP) for detecting pharyngoesophageal leaks following hypopharyngeal dysphagia surgery. Study Design: Retrospective cohort study. Methods: Medical records were reviewed of patients undergoing endoscopic (E‐) or open (O‐) Zenker's diverticulectomy (‐ZD) with cricopharyngeal myotomy (‐CPM) and CPM alone from 2008 to 2020 at one academic institution. Exclusion criteria were patients who were fed enterally or underwent repair of epiphrenic diverticula or O‐CPM during laryngectomy. XRP clinical indication, impact on clinical care, and factors associated with use patterns were examined using descriptive statistics and logistic regression (LR). Results: Of 152 subjects, 52% underwent O‐ZD, 30% O‐CPM, 15% E‐ZD, and 3% E‐CPM. An XRP was ordered for 65% of subjects, mostly routinely (94%). Among the four clinically apparent leaks observed in this cohort, early postoperative XRP confirmed one. It did not identify any clinically silent leaks. In univariate LR, undergoing XRP was associated with increasing day of diet advancement (odds ratio [OR] 4.7, 95% confidence interval [CI] 2.5–10.5) and hospital stay duration (OR 3.2, 95% CI 2.1–5.2), as well as surgeon specialty of otolaryngology compared to general surgery (OR 12.8, 95% CI 4.8–40.8) and procedure sub‐type (O‐CPM: OR 0.03, 95% CI 0.002–0.16). In multivariate LR, the following variables were significantly associated with XRP use: hospital stay (OR 1.7; 95% CI 1.1–3.0), otolaryngology (OR 105; 95% CI 15.4–2193), O‐CPM (OR 0.03; 95% CI 0.002–0.16), and E‐CPM (OR 0.04, 95% CI 0.002–0.60). Conclusions: Prospective, multi‐institutional studies are needed to confirm the low clinical utility we observed of early, postoperative XRP following hypopharyngeal surgery for dysphagia. Level of Evidence: 3 Laryngoscope, 132:272–277, 2022 [ABSTRACT FROM AUTHOR]
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- 2022
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40. Correlating Dysphagia Severity with Fluoroscopic Parameters in Patients with Zenker's Diverticulum.
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Hanna, Raphael and Randall, Derrick R.
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Zenker's diverticulum (ZD) is an uncommon condition characterized by formation of a pseudodiverticulum in the hypopharynx that presents with considerable variability in swallowing symptomatology. Identifying radiographic features of ZD most associated with clinical impact could prove useful in counseling patients and predicting treatment response. This study was a retrospective case series of patients undergoing videofluoroscopic swallowing studies (VFSS) for Zenker's diverticulum at a tertiary dysphagia center. Anatomic parameters identified on VFSS of patients with ZD were correlated with subjective perception of swallowing using Eating Assessment Tool (EAT-10) scores. Upper esophageal sphincter (UES) opening at the point of maximal distention, area of diverticulum on the lateral view, height of the diverticulum, and entrance angle of the esophagus were measured. We identified 40 patients with ZD (52.5% male, mean age = 71.2 years). Narrow UES opening was significantly correlated with dysphagia severity (r = − 0.3445, p = 0.035). Largest area of diverticulum (r = 0.0188, p = 0.87), diverticulum height (r = 0.1435, p = 0.45), and esophageal entrance angle (r = 0.1677, p = 0.42) were not correlated with EAT-10 scores. Maximum UES opening size was predictive of severity of swallowing dysfunction in patients with ZD. Size of ZD and the angle of bolus entry in patients with ZD are not predictive of swallowing dysfunction. Understanding the predictors of swallowing dysfunction will assist in counseling patients on postoperative expectations. [ABSTRACT FROM AUTHOR]
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- 2021
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41. Z-POEM as a Treatment Option for Zenker’s Diverticulum: Our Experience at a Tertiary Care Centre in India
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Pankaj N. Desai, Mayank V. Kabrawala, Chintan N. Patel, Rajiv M. Mehta, Subhash K. Nandwani, Ritesh Prajapati, Nisharg Patel, and Krishna K. Parekh
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septotomy ,submucosal tunneling endoscopy ,zenker’s diverticulum ,z-poem ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background This study was aimed to evaluate efficacy and safety of Z–peroral endoscopic myotomy (Z-POEM; submucosal tunneling endoscopic myotomy) for Zenker’s diverticulum (ZD). Methods This is a retrospective study at a single tertiary care center in India. The Z-POEM technique was performed using principles of submucosal tunneling endoscopy with prior experience from POEM technique for achalasia cardia Results Sixteen patients (male, 62.5%; mean age, 73.2 ± 5.2 years) were included with a mean Charleson’s comorbidity index of 4.32. The mean size of ZD was 34.8 ± 10.0 mm. The technical success rate was 100%. Clinical success was achieved in 100% (16/16) with a decrease in mean dysphagia score from 2.9 to 0.2 (p
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- 2020
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42. Pressure abnormalities in patients with Zenker's diverticulum using pharyngeal high‐resolution manometry
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Sarah P. Rosen, Corinne A. Jones, Matthew R. Hoffman, Molly A. Knigge, and Timothy M. McCulloch
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manometry ,upper esophageal sphincter ,Zenker's diverticulum ,Otorhinolaryngology ,RF1-547 ,Surgery ,RD1-811 - Abstract
Abstract Objectives Zenker's diverticulum is associated with reduced cricopharyngeal compliance and abnormal intrabolus pressure. However, it is unclear how the pharynx compensates for these deficits. Developments in manometric technology have improved our ability to capture pharyngeal pressure events. This study aims to describe the pharyngeal‐upper esophageal sphincter (UES) pressure profile during swallowing in patients with Zenker's diverticulum. Methods High‐resolution manometry was performed on 11 patients with symptomatic Zenker's diverticulum and 11 age‐ and sex‐matched healthy controls during 10 mL liquid swallowing tasks. Pharyngeal and UES pressure magnitudes, durations, and integrals were compared between patients and controls using independent t tests. Other manometric parameters, including residual UES pressure at the time of maximum tongue base pressure and pharyngeal‐UES pressure gradient, were also evaluated. A case example using three‐dimensional high‐resolution manometry is presented. Results Compared with healthy controls, patients with Zenker's diverticulum exhibited pressure abnormalities in the UES region. While baseline and pre‐opening maximum pressures were not different, residual pressures were elevated (P = .001). Pharyngeal‐UES pressure gradients did not differ between the two groups. Conclusion This study used high‐resolution manometry to characterize pharyngeal pressure dynamics in patients with Zenker's diverticulum. The changes occurring at the cricopharyngeus appear to result in persistent UES pressurization during UES opening, rather than high tonic resting pressure. Pharyngeal‐UES pressure gradients, critical to bolus passage, were also preserved in this patient population. Level of Evidence 3b.
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- 2020
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43. First successful experience of the Zenker's diverticulum endoscopic therapy in Kazakhstan
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Kanat Batyrbekov, Alexey Zelenyy, and Ainur Galiakbarova
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zenker's diverticulum ,endoscopic therapy ,septicotomy ,tunnel dissection ,diverticuloesophagostomy ,Internal medicine ,RC31-1245 - Abstract
Zenker's diverticulum tends to occur in the elderly and is generally a relatively rare disorder; the prevalence of Zenker's diverticulum is 1.5–5% of all esophageal diverticula. Men are affected 2-3 times more frequently than women. To date, Zenker's diverticulum is treated mostly by surgery in Kazakhstan, however, with the development of endoscopy the minimally invasive method, endoscopic diverticuloesophagostomy, is being implemented. The transoral treatment is aimed at creating the common cavity between the esophagus and the diverticulum in order to prevent food accumulation in the diverticulum. The anterior wall between these two structures consists of the diverticular wall, m. сricopharyngeus and esophagus wall, the septum transsection automatically ensures myotomy. Both open surgery and endoscopic transoral treatment of Zenker's diverticulum result in reduced symptoms in 94–100% of patients. The paper reports the first successful experience of the Zenker's diverticulum treatment by endoscopic submucosal tunnel dissection in Kazakhstan.
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- 2020
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44. Zenker's diverticulum: A case study of dysphagia in an elderly gentleman.
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Dahal P, Malla SK, Upadhyaya RP, Parajuli S, and Dhakal N
- Abstract
Zenker's diverticulum (ZD) is an acquired, false, and pulsion diverticulum formed by the protrusion of mucosa and submucosa through Killian's dehiscence. The index case is a 91-year-old Nepali patient with a known history of diabetes mellitus, hypertension, rheumatic heart disease, and stage 4 chronic kidney disease, who has been experiencing dysphagia, halitosis, and chronic cough for 25 years. A computed tomography (CT) scan of the chest revealed an outpouching filled with air, fluid, and some solid contents, arising at the level of the cricoid cartilage and extending posteriorly to the esophagus, compressing it. A barium swallow test was performed for confirmation and revealed similar findings. The patient was counseled for surgery but declined due to old age and comorbidities. ZD is commonly seen in the geriatric population and patients with neuromuscular discordance. Barium swallow and CT chest scans can diagnose ZD, and surgery is the mainstay of treatment., (© 2024 The Authors.)
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- 2024
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45. Seven-Year Experience of Intramural Surgery in the Middle East: A Safety and Feasibility Analysis.
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Restrepo-Rodas G, Barajas-Gamboa JS, Dang JT, Piechowska-Jóźwiak MI, Khan M, Diaz Del Gobbo G, Abdallah M, Moreno C, Abril C, Pantoja JP, Guerron AD, Corcelles R, Kroh M, and Rodriguez J
- Abstract
Background: Intramural surgery techniques, particularly esophageal peroral endoscopic myotomy (E-POEM), gastric peroral endoscopic myotomy (G-POEM), and peroral endoscopic myotomy for Zenker's (Z-POEM), have emerged as forefront minimally invasive endoscopic procedures. While several studies have reported on the outcomes in North America and Asia, evidence in the Middle East and North Africa remains limited. This study aims to evaluate the feasibility and safety of intramural surgery techniques within this region. Methods: This retrospective cohort study was conducted with approval from the institutional review board. All patients who underwent esophageal peroral endoscopic myotomy, gastric peroral endoscopic myotomy, and peroral endoscopic myotomy for Zenker's from January 2016 to August 2023 were included. Results: In total, 119 patients underwent intramural surgery procedures during this period. The esophageal peroral endoscopic myotomy group had 81 (68%) patients, the gastric peroral endoscopic myotomy had 34 (28.6%) patients, and the peroral endoscopic myotomy for Zenker's had 4 (3.4%) patients. The full cohort was 48.7% female, with a mean overall age of 40.5 years. The mean overall body mass index was 27.5 kg/m
2 . The chief complaint was dysphagia ( n = 80, 67.2%). All cases were successfully completed endoscopically. During the first 30 days, the most common complications were nausea/vomiting requiring admission ( n = 4, 4.76%) and pneumomediastinum ( n = 2, 2.38%). At a follow-up of 19 months, there were four mortalities; the causes of death were cardiac arrest (three cases) and end-stage prostate cancer (one case). Conclusions: Intramural surgery techniques are safe and technically feasible with low complication rates. Our study suggests that clinical success in the Middle East and Northern Africa population is comparable to larger international series.- Published
- 2024
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46. Cricopharyngomyotomy: Outcomes of flexible endoscopic management of small and medium sized Zenker's diverticulum.
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Holland AM, Lorenz WR, Ricker AB, Mead BS, Scarola GT, and Colavita PD
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Background: Zenker's diverticulum (ZD) was historically treated with an open transcervical myotomy with diverticulectomy, but endoscopic approaches have gained popularity, though with little recent data. This study aimed to report flexible endoscopic cricopharyngomyotomy (FEC) outcomes, particularly in smaller diverticula., Methods: Patients with ZD treated with FEC at a tertiary center were reviewed. Patients were grouped by diverticulum size: small (sZD)≤1.5 cm; medium (mZD) > 1.5 cm., Results: Of 30 patients, median age, BMI, sex, and comorbidities were similar between sZD (n = 18) and mZD (n = 12). Overall, 80.0 % had the procedure performed with a needle knife. Median number of clips for mucosotomy closure (5.0[5.0,6.0]vs.7.0[5.0,7.0]clips;p = 0.051), operative time (59.5[51.0,75.0]vs.74.5[51.0,93.5]minutes;p = 0.498), length-of-stay (1.0[1.0,1.0]vs.1.0[1.0,1.0]days;p = 0.397), and follow-up (20.8[1.1,33.4]vs.15.6[5.4,50.4]months;p = 0.641) were comparable. There were no postoperative leaks; incomplete myotomy occurred in one sZD, yielding a clinical success rate of 96.7 %., Conclusions: FEC has a high success rate for ZD and an advantage in small diverticula, difficult to treat with stapling or open technique., Competing Interests: Declaration of competing interest P. Colavita, MD is a research grant recipient from Medtronic; however, this grant is unrelated to the study and has not affected the objectivity of the data. A. Holland, MD, W. Lorenz, MD, A. Ricker, MD, B. Mead, MD, and G. Scarola, MS have no conflicts of interest or financial ties to disclose. There is nothing related to intellectual property that needs to be disclosed. Authors do not participate in any activities or organizations that may compete with or impact this study. This study was not funded by any outside entity other than ourselves, including specific funding agencies in the public, commercial, or not-for-profit sectors. Finally, we have not utilized artificial intelligence writing assistance in the creation of this manuscript., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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47. Effect of tobacco use on Zenker's diverticulotomy outcomes.
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Peraza LR, Wallerius KP, Bowen AJ, Hernandez-Herrera GA, O'Byrne TJ, Aden AA, Bayan SL, Wong Kee Song LM, and Ekbom DC
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- Humans, Male, Female, Retrospective Studies, Aged, Middle Aged, Treatment Outcome, Postoperative Complications epidemiology, Postoperative Complications etiology, Tobacco Use adverse effects, Cross-Sectional Studies, Zenker Diverticulum surgery, Recurrence
- Abstract
Objective: To compare clinical outcomes in patients with and without history of tobacco use who underwent Zenker's diverticulotomy (ZD)., Study Design: Single institution retrospective review., Setting: Tertiary care academic hospital., Methods: A retrospective review of patients who underwent ZD via an open stapler, rigid endoscopic CO2 laser, stapler or harmonic scalpel, and flexible endoscopic technique from January 2006 to December 2020 was performed. Data were abstracted for patient demographics, diverticular features, and rates of adverse events and symptomatic recurrence., Results: Out of 424 patients, 146 (34.4 %) had a history of tobacco use: 126 (29.7 %) were former smokers, and 20 (4.7 %) were active smokers. In univariable cross-sectional analyses, the likelihood of postoperative bleeding, perforation, emergency department visits, unplanned readmission, or recurrence did not demonstrate an association with tobacco use history even after adjustment for age, sex, and surgical approach. Similarly, in Cox Proportional Hazards regression, tobacco use was not associated with an increased risk of recurrence, even after correcting for age, sex, and type of surgery. The median time to recurrence observed in our cohort was 11.5 years amongst non-smokers, 8.7 years amongst former smokers, and 1.2 years amongst active smokers (p = 0.94)., Conclusions: There were no significant differences in post-operative adverse events or frequency of recurrence of ZD between active, former, and non-smokers. Although underpowered and not statistically significant, median time to recurrence appears to be shorter in smokers when compared with former and non-smokers following surgery., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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48. Analysis of Google Searches in Laryngology: Where Do People Look and Are the Answers They Find Credible?
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Lancaster B, McClutchy C, Schieve H, Ruckart JD Jr, Ruckart KW, and Madden LL
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Objectives: Patients recently diagnosed with a new medical condition frequently search the internet to learn about their diagnosis. We aimed to identify specific questions people ask regarding common laryngological diagnoses by evaluating "People Also Ask" (PAA) questions generated by Google, search volume of these diagnoses, and to determine if the sources accessed were credible., Study Design: Descriptive study., Methods: The terms "subglottic stenosis" (SS), "Zenker's diverticulum" (ZD), "vocal fold paralysis" (VFP), and related terms were entered into Google. PAA questions and associated websites were then extracted using Ahrefs software. Questions were categorized into specific topics. Websites were categorized by type and then assessed using the Journal of the American Medical Association (JAMA) benchmark criteria. A search engine optimization tool was used to determine search volume for individual topics., Results: One hundred and forty-four PAA questions (SS n = 52, ZD n = 49, and VFP n = 43) and their associated websites were extracted. Inquiries were most related to disease etiology (34%), management (27.1%), and signs/symptoms (16.7%). Sources most commonly linked to PAA questions were academic (37.6%), government (25.6%), and commercial (16.2%) websites, while medical practice (7.69%), single surgeon (3.42%), and social media (9.40%) websites were less frequently referenced. JAMA scores were highest for government websites (mean 3.35, standard deviation = 0.54) and lowest for academic websites (mean 0.77, standard deviation = 0.14)., Conclusions: The most asked questions regarding SS, ZD, and VFP are related to etiology and management. Academic medical institution websites are most frequently viewed to answer these questions. Therefore, academic laryngological professionals should ensure the information on their websites is current and accurate., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)
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- 2024
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49. Peroral Endoscopic Myotomy Is a Safe and Feasible Option in Management of Esophageal Diverticula: Systematic Review and Meta-Analysis.
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Kamal, Faisal, Khan, Muhammad Ali, Lee-Smith, Wade, Sharma, Sachit, Marella, Hemnishil K., Iqbal, Umair, Mcdonough, Stephanie, Aslam, Aysha, Ismail, Mohammad K., Tombazzi, Claudio, and Adler, Douglas G.
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DIVERTICULUM , *MYOTOMY , *RANDOM effects model , *QUALITY of life , *SYMPTOMS - Abstract
Esophageal diverticula can cause significant symptoms and affect the quality of life. There has been recent interest in the use of peroral endoscopic myotomy in the management of esophageal diverticula (D-POEM). In this meta-analysis, we have evaluated the efficacy and safety of D-POEM in the management of esophageal diverticula. Several databases were reviewed from inception to 6/19/2020 to identify the studies evaluating the feasibility, efficacy and safety of D-POEM in the management of esophageal diverticula. Our outcomes of interest were technical success, adverse events and difference in mean pre- and post-procedure symptom score. We performed subgroup analysis including patients with Zenker's diverticulum who underwent POEM (Z-POEM). Pooled rates with 95% confidence intervals (CI) for all outcomes were calculated using random effect model. We calculated standard mean difference (SMD) with 95% CI to compare mean pre- and post-procedure symptom score. We included 7 studies with 233 patients. For D-POEM, pooled rates (95% CI) for technical success and adverse events were 95% (91%, 97%) and 6% (3%, 10%) respectively. For Z-POEM, pooled rates (95% CI) for technical success and adverse events were 95% (90%, 97%) and 6% (3%, 10%) respectively. Mean post-procedure symptom score for all patients who underwent D-POEM was significantly lower compared to mean pre-procedure symptom score, SMD (95% CI) 2.17 (1.51, 2.83). This meta-analysis demonstrated that D-POEM is a safe and feasible option for patients with symptomatic esophageal diverticula. [ABSTRACT FROM AUTHOR]
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- 2021
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50. Flexible endoscopy assisted by Ligasure™ for treatment of Zenker's diverticulum: an effective and safe procedure.
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Alfaro, Enrique, Cañamares, Pablo, Sostres, Carlos, Simón, Miguel Ángel, and Ducons, Julio
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ENDOSCOPY , *DIVERTICULUM , *SYMPTOMS , *DEGLUTITION disorders - Abstract
Background: Flexible endoscopy allows use of the vessel–tissue sealer Ligasure™ (Covidien, Massachusetts, USA) to perform diverticulotomy. Few studies have used this endoscopic approach in the uncommon disorder Zenker's diverticulum. The aim of the present study was to evaluate the effectiveness and safety of flexible endoscopy treatment assisted by Ligasure™. Methods: The single-center prospective and descriptive study included patients treated by flexible endoscopy using Ligasure™ for resection of Zenker's diverticulum. Consecutive patients were included from March 2009 to April 2018. Patients were censored until the end of follow-up or death. Complications, symptoms before treatment, type of sedation, and number of interventions needed to resolve Zenker's diverticulum were analyzed. Bleeding complications were considered when a case required a second endoscopy. Results: A total of 46 symptomatic patients with Zenker's diverticulum were included in the final analysis (41.3% women, median age of 73.7 ± 11 years). The median follow-up period was 37.21 ± 28 months. Of all cases, 58.7% were considered small (< 3 cm). Solid or semi-solid food-related dysphagia was present in 55.6% of patients previously to the procedure. The technique was successful in a single procedure in 78.3% of cases. However, the success rate increased to 89.1% with a second procedure, and we had a complication rate of 4.3% with this technique. Most patients (79.66%) were managed as out-patients or with short (< 24 h) admission. Conclusion: In this large case series, treatment of Zenker's diverticulum based on flexible endoscopy assisted by Ligasure™ was a safe and effective procedure with a high success rate in a few endoscopy sessions and low complication rate. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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