Endoscopic treatment of Zenker's diyerticulum by harmonic scalpel

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorHONDO, Fabio Yuji
dc.contributor.authorMALUF-FILHO, Fauze
dc.contributor.authorGIORDANO-NAPPI, Jose Humberto
dc.contributor.authorNEVES, Carla Zanelatto
dc.contributor.authorCECCONELLO, Ivan
dc.contributor.authorSAKAI, Paulo
dc.date.accessioned2017-11-27T16:27:07Z
dc.date.available2017-11-27T16:27:07Z
dc.date.issued2011
dc.description.abstractBackground: 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.
dc.description.indexMEDLINE
dc.identifier.citationGASTROINTESTINAL ENDOSCOPY, v.74, n.3, p.666-671, 2011
dc.identifier.doi10.1016/j.gie.2011.05.007
dc.identifier.issn0016-5107
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/22995
dc.language.isoeng
dc.publisherMOSBY-ELSEVIER
dc.relation.ispartofGastrointestinal Endoscopy
dc.rightsrestrictedAccess
dc.rights.holderCopyright MOSBY-ELSEVIER
dc.subject.otherargon plasma coagulation
dc.subject.otherdiverticulum
dc.subject.otherultracision
dc.subject.wosGastroenterology & Hepatology
dc.titleEndoscopic treatment of Zenker's diyerticulum by harmonic scalpel
dc.typearticle
dc.type.categoryoriginal article
dc.type.versionpublishedVersion
dspace.entity.typePublication
hcfmusp.author.externalNEVES, Carla Zanelatto:Univ Sao Paulo, Sch Med, Gastrointestinal Endoscopy Unit, Sao Paulo, Brazil
hcfmusp.citation.scopus34
hcfmusp.contributor.author-fmusphcFABIO YUJI HONDO
hcfmusp.contributor.author-fmusphcFAUZE MALUF FILHO
hcfmusp.contributor.author-fmusphcJOSE HUMBERTO GIORDANO NAPPI
hcfmusp.contributor.author-fmusphcIVAN CECCONELLO
hcfmusp.contributor.author-fmusphcPAULO SAKAI
hcfmusp.description.beginpage666
hcfmusp.description.endpage671
hcfmusp.description.issue3
hcfmusp.description.volume74
hcfmusp.origemWOS
hcfmusp.origem.pubmed21872715
hcfmusp.origem.scopus2-s2.0-80052190593
hcfmusp.origem.wosWOS:000294660200029
hcfmusp.publisher.cityNEW YORK
hcfmusp.publisher.countryUSA
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