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.
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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.
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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


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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


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