Divertículo faringoesofagiano: avaliação dos resultados do tratamento

Henry, Maria Aparecida Coelho de Arruda; Lerco, Mauro Masson; Tagliarini, José Vicente; Castilho, Emanuel Celice; Novaes, Fabiola Trocoli; Lamonica, Vania Cristina

doi:10.1590/s0100-69912013000200004

Cited by 7 publications

(14 citation statements)

References 25 publications

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“…Usually, elderly patients tended to be treated with an endoscopic approach, as it has lower rates of complications and a shorter hospital stay 2. Considering that patients with Zenker’s diverticulum usually have many comorbidities, their clinical condition is essential to define the best treatment.…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic versus surgical approach in the treatment of Zenker’s diverticulum: systematic review and meta-analysis

et al. 2016

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Background: Zenker?s diverticulum is a rare disease in the general population. Its treatment can be carried out by either an endoscopic or surgical approach. The objective of this study was to systematically identify all reports that compare both treatment modalities and to assess the outcomes in terms of length of procedure, length of hospitalization, time until diet introduction, complication rates, and recurrence rates. Methods: A search of Medline and Embase selected all studies that compared different methods of surgical and endoscopic treatment for Zenker?s diverticulum published in the English, Portuguese, and Spanish languages between 1975 and 2014. The meta-analysis was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Data were extracted and analyzed for five different outcomes. Results: Eleven studies met the inclusion criteria, describing outcomes of endoscopic versus surgical treatment for 596 patients with Zenker?s diverticulum. A meta-analysis of the studies suggested a statistically significant reduction in operating time and length of hospitalization, favoring endoscopic treatment (standardized mean difference (SMD)???78.06, 95?%CI???90.63,???65.48 and SMD???3.72, 95?%CI???4.49,???2.95, respectively), just as with the reduction in the fasting period (SMD???4.30, 95?%CI???5.18,???3.42) and risk of complications (SMD???0.09, 95?%CI 0.03, 0.43) for patients who had undergone the endoscopic approach in comparison with the surgical group.?Also, a statistically significant reduction in the risk of symptom recurrence was seen when the treatment of Zenker?s diverticulum was carried out by a surgical approach compared with endoscopic treatment (SMD 0.08, 95?%CI 0.03, 0.13). Conclusion: Compared with a surgical approach, endoscopic treatment appeared to result in a shorter length of procedure and hospitalization, earlier diet introduction, and lower rates of complications, but in higher rates of symptom recurrence.

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Section: Discussionmentioning

confidence: 99%

“…It is an acquired prolapse of the mucosal and submucosal layers located dorsally at the pharyngoesophageal junction through Killian’s triangle 2. It is the most common type of esophageal diverticula with a reported prevalence ranging between 0.01 % and 0.11 %, and typically occurs in middle-aged and elderly patients 3 4.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic versus surgical approach in the treatment of Zenker’s diverticulum: systematic review and meta-analysis

et al. 2016

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“…The three patients who did not respond to the treatment were classified as stage II in the functional outcome swallowing scale at 18 months of follow-up. The average time of the procedure was 32 minutes in the SM group and 12 (7)(8)(9)(10)(11)(12)(13)(14)(15) minutes in the MD group (p <0.001). Conclusions: ZD myotomy with flexible endoscopy using an overtube has potential benefits in terms of shorter operative times, shorter post-operative stays, and an earlier reintroduction of food.…”

Section: Introductionmentioning

confidence: 94%

“…Los signos de alarma como el dolor local y la hemoptisis o hematemesis pueden indicar ulceración o carcinoma de células escamosas dentro del divertículo de Zenker, que tiene una incidencia de 0,4 % a 1,5 % (6,9). La videofluoroscopia con trago de bario es útil para el diagnóstico: proporciona información sobre el tamaño y la ubicación, y en ocasiones puede identificar lesiones mucosas en el saco diverticular (10,11); además, puede realizar el diagnóstico diferencial del divertículo de Killian-Jamieson, menos común y más pequeño, que surge en el esófago cervical proximal anterolateral y es inferior al músculo cricofaríngeo (12). Aunque útil, la videofluoroscopia con trago de bario tiene un rendimiento diagnóstico que está condicionado por las variaciones en la calidad en la realización y la interpretación de estos estudios.…”

Section: Materiales Y Métodosunclassified

“…Los tres pacientes que no respondieron presentaron en el seguimiento a 18 meses un estadio II de la escala de deglución de resultados funcionales. El tiempo promedio del procedimiento fue de 32 minutos en el grupo del método estándar y 12 (7)(8)(9)(10)(11)(12)(13)(14)(15) minutos en el grupo de método con diverticulotomo (p < 0,001). Conclusiones: La miotomía del divertículo de Zenker con el uso de endoscopia flexible utilizando el diverticulotomo tiene beneficios potenciales en términos de tiempos operatorios más cortos, estancias posoperatorias más cortas y un inicio más temprano de la dieta.…”

Section: Introductionunclassified

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Divertículo de Zenker: manejo endoscópico con o sin diverticulotomo

Zuleta

Ruíz

Fernández

2020

Rev Colomb Gastroenterol

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El divertículo de Zenker se define como un divertículo localizado en la pared esofágica posterior que tiene como cuello proximal al músculo cricofaríngeo. La mayoría de los pacientes presenta síntomas después de los 60 años de edad. Antes el manejo estándar se realizaba la diverticulotomía quirúrgica, pero desde hace más de 20 años se introdujo el manejo endoscópico. Desde hace más de 15 años se introdujo un diverticulotomo que facilita la realización del procedimiento, pero su uso no se ha instaurado ampliamente en Colombia. Por ello, el objetivo de este estudio es evaluar si la diverticulotomía endoscópica con el uso de este dispositivo es más fácil (rápida) que el método estándar. Materiales y métodos: se realizó un estudio prospectivo evaluando dos métodos endoscópicos para tratar el divertículo de Zenker, con el objetivo principal de conocer en cuál de ellos el tiempo de incisión del tabique era menor. El tiempo del procedimiento se contaba después de la colocación de la sonda en el método estándar o después de colocar el diverticulotomo en posición (método con diverticulotomo), ya que es el momento exacto en el cual se inicia el corte del tabique y se contabilizaba eltiempo (registro en video) cuando este corte terminaba. Resultados: de enero de 2015 a diciembre de 2018 en total se incluyeron 20 pacientes. El diagnóstico de Zenker fue realizado por una endoscopia y esofagograma para clasificar el tamaño del mismo. El promedio de edad de los pacientes fue de 61 años (46-85). En cada uno de los grupos se asignaron 10 pacientes. En 7 pacientes del grupo método estándar se resolvieron los síntomas, en comparación con 9 del grupo del método con diverticulotomo. Los tres pacientes que no respondieron presentaron en el seguimiento a 18 meses un estadio II de la escala de deglución de resultados funcionales. El tiempo promedio del procedimiento fue de 32 (25-45) minutos en el grupo del método estándar y 12 (7-15) minutos en el grupo de método con diverticulotomo (p < 0,001). Conclusiones: La miotomía del divertículo de Zenker con el uso de endoscopia flexible utilizando el diverticulotomo tiene beneficios potenciales en términos de tiempos operatorios más cortos, estancias posoperatorias más cortas y un inicio más temprano de la dieta. Desde el punto de vista técnico, permite una mejor exposición del tabique, lo que facilita su corte, pero se necesitan estudios más grandes para confirmar estos resultados.

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Comparison of Surgical Treatments for Zenker Diverticulum

Bhatt

Mendoza

Kallogjeri

et al. 2021

JAMA Otolaryngol Head Neck Surg

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IMPORTANCEZenker diverticulum (ZD) can cause significant dysphagia, and symptoms can return or persist after surgery. This systematic review and network meta-analysis is the first to our knowledge to compare 3 common surgical techniques for ZD. OBJECTIVE To compare the 3 most common surgical techniques-endoscopic laser-assisted diverticulotomy, endoscopic stapler-assisted diverticulotomy, and transcervical diverticulectomy with cricopharyngeal myotomy-in adult patients with ZD.DATA SOURCES The published literature was searched using strategies designed by a medical librarian (search performed September 21, 2018). Strategies were established using a combination of controlled vocabulary terms and keywords and were executed in Ovid MEDLINE (1946 to September 21, 2018), Embase (1947 to September 21, 2018, Scopus (1823 to September 21, 2018), Cochrane Library, and ClinicalTrials.gov. Results were limited to English using database-supplied filters, which generated studies from 1997 to 2017.STUDY SELECTION Inclusion criteria were cohort studies or randomized clinical trials. Studies that included patients needing revision surgery or undergoing an alternative technique were excluded. DATA EXTRACTION AND SYNTHESISThe Preferred Reporting Items for Systematic Reviews and Meta-analyses-Network Meta-analyses (PRISMA-NMA) checklist was used to report the study findings. Two authors independently reviewed the studies. MAIN OUTCOME AND MEASUREThe primary outcome measure was the incidence of persistent or recurrent symptoms following surgery. The primary study outcome was planned before data collection began. RESULTSThe search generated 529 studies. After applying inclusion and exclusion criteria, 9 cohort studies remained, consisting of 903 patients treated with either laser-assisted diverticulotomy (n = 283), transcervical diverticulectomy (n = 150), or stapler-assisted diverticulotomy (n = 470). A network meta-analysis was performed. Between endoscopic laser-assisted diverticulotomy and open diverticulectomy, the open approach showed a statistically lower likelihood of persistent/recurrent symptoms following treatment (odds ratio [OR], 0.20; 95% CI, 0.04-0.91). Comparing laser-assisted diverticulotomy with the stapler-assisted technique, there was not a significant difference between the 2 techniques (OR, 0.83; 95% CI, 0.43-1.60). The consistency model for the network meta-analysis was supported (χ 2 1 = 0.12; P = .73).CONCLUSIONS AND RELEVANCE This systematic review and meta-analysis compared 3 common techniques for treating ZD. The open approach showed a decreased likelihood of persistent or recurrent symptoms following surgery compared with the 2 other techniques.

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Divertículo faringoesofagiano: avaliação dos resultados do tratamento

Cited by 7 publications

References 25 publications

Endoscopic versus surgical approach in the treatment of Zenker’s diverticulum: systematic review and meta-analysis

Endoscopic versus surgical approach in the treatment of Zenker’s diverticulum: systematic review and meta-analysis

Divertículo de Zenker: manejo endoscópico con o sin diverticulotomo

Comparison of Surgical Treatments for Zenker Diverticulum

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