Year 2019 / Volume 111 / Number 5
Original
A long-term prospective study of the efficacy and safety of endoscopic septotomy using the LigaSure® system for the treatment of Zenker’s diverticulum

378-383

DOI: 10.17235/reed.2019.5915/2018

Vicente Pons-Beltrán, Natalia García Morales, Esteban Sáez-González, Noelia Alonso, Marta Ponce, Marco Bustamante, Lidia Argüello,

Abstract
Background and objectives: endoscopic septotomy of the cricopharyngeal muscle (ESCM) is a technique used for the treatment of Zenker’s diverticulum (ZD). The experience with computerized vascular sealing systems (LigaSure® type) is limited. The objective of this study was to evaluate the efficacy and safety of ESCM using LigaSure®. Methods: this was a long-term prospective study of 18 patients with ZD, who were referred to our hospital due to ESCM between 2010 and 2016. The severity of the symptoms was determined using the Dakkak-Bennett validated scale for dysphagia and the rest with numerical scales. The rates of relapse and retreatment were evaluated. Results: ESCM with LigaSure® was performed in 17 cases, one case was excluded due to technical difficulties. The median age was 72 years and regurgitation, dysphagia and respiratory symptoms were found in 100%, 89% and 56% of cases, respectively. The median size of the diverticulum was 28 mm (20-60 mm). The median time of the procedure was 35 minutes (25-45 minutes). There were four complications, two hemorrhages and two perforations. The median follow-up was 13 months (range: 12-82 months). Clinical improvements were observed for all symptoms and were maintained 12 months after treatment (p < 0.05). There was no relapse during follow-up in 13 patients. A complete section was not achieved and clinical relapse occurred after a median time of seven months that required retreatment in the remaining patients. Conclusions: ESCM with LigaSure® may be a safe and effective technique in long-term follow-up situations, with low rates of relapse.
Share Button
New comment
Comments
No comments for this article
References
1. Battaglia G, Antonello A, Realdon S, Cesarotto M, Zanatta L, Ishaq S. Flexible endoscopic treatment for Zenker’s Diverticulum with the SB Knife. Preliminary results from a single-center experience. Dig Endosc. 2015; 27: 729-734.
2. Ferreira LE, Simmons Dt, Baron TH. Zenker’s diverticula: pathophysiology, clinical presentation and flexible endoscopic management. Dis Esophagus. 2008;21(1):1-8.
3. Dzeletovic I, Ekbom DC, Baron TH. Flexible endoscopic and surgical management of Zenker's diverticulum. Expert Rev. Gastroenterol Hepatol. 2012; 6: 449-66.
4. Nielsen HU, Trolle W, Homoe P. New technique using LigaSure for endoscopic mucomyotomy of Zenker’s diverticulum: Divertucolotomy made easier. Laryngoscope. 2014; 124:2039-42.
5. Moreira da Silva BA, Germade A, Pérez Cítores L, et al. Diverticulotomía endoscópica utilizando Ligasure. Gastroenterol Hepatol. 2017; 40 (2): 80-84.
6. Goelder SK, Brueckner J, Messmann H. Endoscopic treatment of Zenker’s diverticulum with the stag beetle knife (sb knife) – feasibility and follow-up. Scand J Gastroenterol. 2016;51(10):1155-8
7. Juzgado L. Crico-faringo-mío-septotomía endoscópica flexible: “gold standard” en el tratamiento del divertículo de Zenker. Rev Esp Enferm Dig. 2016; 108:295-296.
8. De la Morena, EJ, Pérez Arellano E, Rodríguez García I. Tratamiento endoscópico flexible del divertículo de Zenker: trece años de experiencia en España. Rev Esp Enferm Dig. 2016; 108: 297-303.
9. Gonzalez N, Viola M, Costa X, Gamba A. Endoscopic treatment of Zenker’s diverticulum by LigaSure scalpel. Endoscopy. 2014;46 Suppl- 1:E229-30.
10. Herrero Egea A, Pérez Delgado L, Tejero-Garcés Galve G, Guallar Larpa M, Orte Aldea C, Ortiz García A. Tratamiento del Divertículo de Zenker: comparación de diferentes técnicas. Acta Otorrinolaringol Esp. 2013;64:1-5
11. Noguera-Aguilar J, Dolz-Abadía C, Vilella A, et al. Transoral endoluminal approach to Zenker's diverticulum using LigasureTM: early clinical experience. Rev Esp Enferm Dig 2014;106(2):137-41.
12. Michelle Fog Andersen,Waldemar Trolle,Kristian Anthonsen,Hans Ulrik Nielsen, Preben Homøe. Long-term results using LigaSure™ 5 mm instrument for treatment of Zenker’s diverticulum. Eur Arch Otorhinolaryngol (2017) 274:1939–1944.
13. Dakkak M, Bennet Jr. A new dysphagia score with objective validation. J Clin Gastroenterol. 1992; 14:99-100.
14. Morton RP, Bartley JR. Inversion of Zenker’s diverticulum: the preferred option. Head Neck. 1993; 15: 253-6.
15. Cañete-Gómez J, Ramírez-Plaza CP, López Rueda B, et al. Diverticulectomía y miotomía del cricofaríngeo para el tratamiento del divertículo de Zenker. Presentación de una serie de 33 casos. Cir Esp. 2012;90:233-7.
16. Ishaq S, Hassan C, Antonello A, et al. Flexible endoscopic treatment for Zenker’s diverticulum: a systematic review and meta-analysis. Gastrointest Endosc. 2016;83(6):1076-1089.
17. Brueckner J, Schneider A, Messmann H, et al. Long-term symptomatic control of Zenker diverticulum by flexible endoscopic mucomyotomy with the hook knife and predisposing factors for clinical recurrence. Scand J Gastroenterol. 2016;51:666-71.
18. Huberty V, El Bacha S, Blero D, et al. Endoscopic treatment for Zenker's diverticulum: long-term results. Gastrointest Endosc 2013;77:701-7.
19. Smith SR, Genden EM, Urken ML. Endoscopic stapling technique for the treatment of Zenker diverticulum vs standard open neck technique: a direct comparison and charge analysis. Arch Otolaryngol Head Neck Surg. 2002; 128: 141-4.
20. Repici A, Pagano N, Romeo F, et al. Endoscopic flexible treatment of Zenker’s diverticulum: a modification of the needle knife technique. Endoscopy 2010; 42: 532-5.
Related articles

Letter

When eating becomes a real nightmare

DOI: 10.17235/reed.2023.10025/2023

Letter

Drug-induced sudden dysphagia

DOI: 10.17235/reed.2023.9989/2023

Digestive Diseases Image

Dysphagia secondary to neuroendocrine carcinoma: a rare esophageal tumor

DOI: 10.17235/reed.2023.9951/2023

Digestive Diseases Image

Solid food dysphagia caused by aortic arch malformation compressing the esophagus

DOI: 10.17235/reed.2023.9923/2023

Letter

Esophageal necrosis secondary to thoracic aortic aneurysm

DOI: 10.17235/reed.2023.9580/2023

Digestive Diseases Image

Esophageal lichen planus: an unusual case of dysphagia

DOI: 10.17235/reed.2023.9572/2023

Letter

Large symptomatic esophageal diverticulum

DOI: 10.17235/reed.2023.9518/2023

Digestive Diseases Image

A giant cause of recurrent fever

DOI: 10.17235/reed.2022.9340/2022

Letter

Eagle’s syndrome as a cause of oropharyngeal dysphagia

DOI: 10.17235/reed.2022.9295/2022

Letter

Familial dysphagia: eosinophilic esophagitis

DOI: 10.17235/reed.2019.6610/2019

Letter

Esophageal lichen planus: a rare cause of dysphagia

DOI: 10.17235/reed.2019.6064/2018

Letter

Dysphagia lusoria: uncommon cause of dysphagia in children

DOI: 10.17235/reed.2018.5664/2018

Digestive Diseases Image

Dysphagia lusoria: a little-known cause of dysphagia

DOI: 10.17235/reed.2018.5385/2017

Case Report

Peroral endoscopic myotomy in pediatric jackhammer esophagus

DOI: 10.17235/reed.2018.5090/2017

Letter to the Editor

Utility of surgical myotomy in the dysphagia due to oculopharyngeal dystrophy

DOI: 10.17235/reed.2016.4266/2016

Citation tools
Pons-Beltrán V, García Morales N, Sáez-González E, Alonso N, Ponce M, Bustamante M, et all. A long-term prospective study of the efficacy and safety of endoscopic septotomy using the LigaSure® system for the treatment of Zenker’s diverticulum. 5915/2018


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 1343 visits.
This article has been downloaded 164 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 10/09/2018

Accepted: 24/11/2018

Online First: 04/03/2019

Published: 07/05/2019

Article revision time: 74 days

Article Online First time: 175 days

Article editing time: 239 days


Share
This article hasn't been rated yet.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2024 y Creative Commons. The Spanish Journal of Gastroenterology