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Per-oral endoscopic myotomy with septotomy for the treatment of distal esophageal diverticula (D-POEM)
Indexado
WoS WOS:000522996200055
Scopus SCOPUS_ID:85081537509
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


Abstract



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.

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Disciplinas de Investigación



WOS
Surgery
Scopus
Sin Disciplinas
SciELO
Sin Disciplinas

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Publicaciones WoS (Ediciones: ISSHP, ISTP, AHCI, SSCI, SCI), Scopus, SciELO Chile.

Colaboración Institucional



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Autores - Afiliación



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

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Financiamiento



Fuente
Boston Scientific Corporation

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Agradecimientos



Agradecimiento
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.

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