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| DOI | 10.1007/S00464-019-07354-0 | ||||
| Año | 2020 | ||||
| Tipo | artículo de investigación |
Citas Totales
Autores Afiliación Chile
Instituciones Chile
% Participación
Internacional
Autores
Afiliación Extranjera
Instituciones
Extranjeras
Background and aims Epinephric diverticula are frequently associated with esophageal motility disorder. Their management implies surgery, with 15% morbidity and 3% mortality rates. Flexible endoscopy could be an effective and safer approach for treating esophageal diverticulum with motility disorder. We report our experience of seven consecutive cases treated with per-oral endoscopic submucosal septotomy and myotomy (D-POEM). Methods Seven consecutive patients were referred for symptomatic non-zenker's esophageal diverticulum. The steps of the procedure were as follows: (i) analysis of the esophageal anatomy; (ii) vertical mucosal incision just above the upper edge of the diverticulum; (iii) submucosal tunneling by submucosal dissection, alongside the submucosal window of the diverticulum and the downstream septum; (iv) identification of the septum and the diverticular area; (v) diverticular septotomy followed by antegrade esocardial myotomy up to 2 cm below the cardia; and (vi) closure of the mucosal incision. Results Three men and four women aged from 62 to 90 years were treated. Four patients had a diet with adapted texture before the treatment and five patients had weight loss (4 kg to 24 kg). At preoperative evaluation, all had an esophageal motility disorder at high-resolution manometry. The procedures were successfully performed in all the patients without per-operative complications. During the 30 postoperative days, no significant adverse events occurred. Three months after treatment, six patients (85%) had clinical improvement with complete or partial regression of dysphagia. All the patients stabilized or gained weight after the treatment. Conclusion The D-POEM technique is a mini-invasive effective and safe technique to treat symptoms due to both esophageal motility disorder and distal esophageal diverticula. It could be a very interesting solution for non-surgical patients in the first time that could be extended to other patients after favorable larger series.
| Ord. | Autor | Género | Institución - País |
|---|---|---|---|
| 1 | Basile, Paul | Hombre |
Univ Hosp Rouen - Francia
CHU Hopitaux de Rouen - Francia CHU Rouen Normandie - Francia |
| 2 | Gonzalez, Jean-Michel | Hombre |
Hop Nord Marseille - Francia
Univ Hosp Amiens - Francia Hôpital Nord AP-HM - Francia CHU Amiens Picardie - Francia |
| 3 | Gonzalez, Jean-Michel | Hombre |
Hop Nord Marseille - Francia
Univ Hosp Amiens - Francia Hôpital Nord AP-HM - Francia CHU Amiens Picardie - Francia |
| 4 | Irarrazaval, Rodrigo | Hombre |
CLIN DAVILA - Chile
Clínica Dávila - Chile |
| 5 | Caillo, Ludovic | Hombre |
Univ Hosp Nimes - Francia
Centre Hospitalier Universitaire de Nîmes - Francia |
| 6 | Barthet, Marc | Hombre |
Hop Nord Marseille - Francia
Hôpital Nord AP-HM - Francia |
| Agradecimiento |
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| Drs Paul BASILE, Jean-Philippe LE MOUEL and Rodrigo Irarrazaval have no conflicts of interest or financial ties to disclose. Jean-Michel GONZALEZ and Marc BARTHET have a research grant from Boston Scientific to disclose. Dr Ludovic CAILLO is on the speaker’s bureau of Abbvie, Norgine, Janssen, Pfizer, Takeda, and Amgen. |