Endoscopic treatment of Zenker's diyerticulum by harmonic scalpel

Imagem de Miniatura
Arquivos
art_HONDO_Endoscopic_treatment_of_Zenkers_diyerticulum_by_harmonic_scalpel_2011.PDF (1.33 MB)
Citações na Scopus
34
Tipo de produção
article
Data de publicação
2011
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
MOSBY-ELSEVIER
Autores
NEVES, Carla Zanelatto
Citação
GASTROINTESTINAL ENDOSCOPY, v.74, n.3, p.666-671, 2011
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Background: Zenker's diverticulum (ZD) is a rare condition with a reported prevalence of 0.01% to 0.11% in the general population. Endoscopic treatment consists of the division of the septum between the diverticulum and the esophagus, within which the cricopharyngeal muscle is contained. Diathermic monopolar current, argon plasma coagulation, and laser have been used to incise the muscular septum with satisfactory results. The main limitation of endoscopic treatment is the occurrence of complications. Perforation and hemorrhage are reported in as many as 23% and 10% of patients, respectively. Objective: The aim of this study was to use the technique of endoscopic diverticulotomy by using a harmonic scalpel in patients with ZD and to demonstrate the feasibility of using flexible and rigid devices in ZD treatment. Design: Case series study. Standard protocol was used for patient management, endoscopic procedure, and data collection. Setting: Single endoscopist demonstrating preliminary results. Patients: Five patients (4 men; median standard deviation [SD] age 69.6 +/- 9.06 years, range 59-83 years) with ZD were treated with this technique. All patients reported dysphagia and halitosis. The diagnosis was based on clinical, endoscopic, and radiographic findings. Interventions: All patients received general anesthesia and were placed in the left lateral position. A standard videogastroscope (9.8 mm) and a stiff guidewire were used to insert and achieve an adequate exposure of the ZD septum. The septum was divided using a harmonic scalpel under thin endoscope (5.2 mm) visualization through a soft diverticuloscope. Main Outcome Measurement: Feasibility of an endoscopic technique by using rigid and flexible devices to treat ZD. Results: Four patients (80%) were successfully treated in 1 session. The median SD size of the diverticulum was 3.6 +/- 0.89 cm (range 3-5 cm). Median SD procedure time was 17.33 +/- 2.33 minutes (range 15-20 minutes) in 6 procedures. No hemorrhage or perforation occurred. One patient (20%) required a second session to complete dissection of the ZD septum. All patients demonstrated improvement of dysphagia score after treatment. Limitations: Small case series design. Conclusions: Endoscopic treatment of ZD by harmonic scalpel through a soft diverticuloscope was feasible and effective in this small case series. Larger studies are warranted to further evaluate this technique.
Palavras-chave
URI
https://observatorio.fm.usp.br/handle/OPI/22995
Referências
  1. AGGERHOLM K, 1990, J LARYNGOL OTOL, V104, P312, DOI 10.1017/S0022215100112575
  2. Vogelsang A, 2007, ENDOSCOPY, V39, P131, DOI 10.1055/s-2006-944657
  3. Evrard S, 2003, GASTROINTEST ENDOSC, V58, P116
  4. ISHIOKA S, 1995, ENDOSCOPY, V27, P433, DOI 10.1055/s-2007-1005736
  5. Manner H, 2006, DIGEST LIVER DIS, V38, P471, DOI 10.1016/j.dld.2006.03.022
  6. Sakai P, 2001, GASTROINTEST ENDOSC, V54, P760, DOI 10.1067/mge.2001.119606
  7. Watemberg S, 1996, AM J GASTROENTEROL, V91, P1494
  8. Rabenstein T, 2007, ENDOSCOPY, V39, P141, DOI 10.1055/s-2007-966164
  9. Tang SJ, 2008, GASTROINTEST ENDOSC, V67, P704, DOI 10.1016/j.gie.2007.11.006
  10. Ferreira LEVVC, 2008, DIS ESOPHAGUS, V21, P1, DOI 10.1111/j.1442-2050.2007.00795.x
  11. Hondo FY, 2009, ENDOSCOPY, V41, pE104, DOI 10.1055/s-0028-1119605
  12. Diamantis T, 2006, SURG TODAY, V36, P908, DOI 10.1007/s00595-006-3254-1
  13. Costamagna G, 2007, ENDOSCOPY, V39, P146, DOI 10.1055/s-2007-966140
  14. Chistiaens P, 2007, ENDOSCOPY, V39, P137
  15. ENGEL JJ, 1995, GASTROINTEST ENDOSC, V42, P368, DOI 10.1016/S0016-5107(95)70142-7
  16. GROTH S, 2005, ENDOSKOPIE HEUTE, V18, P144, DOI 10.1055/s-2005-872518
  17. Hashiba K, 1999, GASTROINTEST ENDOSC, V49, P93, DOI 10.1016/S0016-5107(99)70452-9
  18. LERUT T, 1990, ACTA GASTRO-ENT BELG, V53, P330
  19. LUDLOW A, 1769, CASE OBSTRUCTED DEGL, V3, P85
  20. MARAN AGD, 1986, CLIN OTOLARYNGOL, V11, P219, DOI 10.1111/j.1365-2273.1986.tb01923.x

Coleções
Artigos e Materiais de Revistas Científicas - FM/MGT
Artigos e Materiais de Revistas Científicas - HC/ICESP
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - HC/InCor
Artigos e Materiais de Revistas Científicas - LIM/35