Submucosal Tunneling Endoscopic Septum Division: A Novel Technique for Treating Zenker's Diverticulum

Li, Quan‐Lin; Chen, Weifeng; Zhang, Xiaocen; Cai, Mingjun; Zhang, Yiqun; Hu, Jianwei; He, Meng‐Jiang; Yao, Ling; Zhou, Ping‐Hong; Xu, Mei‐Dong

doi:10.1053/j.gastro.2016.08.064

Cited by 135 publications

(96 citation statements)

References 4 publications

(3 reference statements)

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“…The prophylactical placement of endoclips at the bottom of the septum after the dissection is a described method to reduce this complication[22]. To avoid perforation, Li et al[23] performed a submucosal tunneling to cut the cricopharyngeal muscle fibers. The fibers were dissected by using a Hybrid knife, the mucosal incision was closed with endoclips.…”

Section: Discussionmentioning

confidence: 99%

New flexible endoscopic controlled stapler technique for the treatment of Zenker's diverticulum: A case series

Wilmsen

Baumbach

Stüker

et al. 2017

WJG

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AIMTo report about the combination and advantages of a stapler-assisted diverticulotomy performed by flexible endoscopy.METHODSFrom November 2014 till December 2015 17 patients (8 female, 9 male, average age 69.8 years) with a symptomatic Zenker diverticulum (mean size 3.5 cm) were treated by inserting a new 5 mm fully rotatable surgical stapler (MicroCutter30 Xchange, Cardica Inc.) next to an ultrathin flexible endoscope through an overtube. The Patients were under conscious sedation with the head reclined in left position, the stapler placed centrally and pushed forward to the bottom of the diverticulum. The septum was divided by the staple rows under flexible endoscopic control.RESULTSIn eleven patients (64.7%) the stapler successfully divided the septum completely. Mean procedure time was 21 min, medium size of the septum was 2.8 cm (range 1.5 cm to 4 cm). In four patients the septum was shorter than 3 cm, in seven longer than 3 cm. To divide the septum, averagely 1.3 stapler cartridges were used. Two minor bleedings occurred. Major adverse events like perforation or secondary haemorrhage did not occur. After an average time of two days patients were discharged from the hospital. In 6 patients (35.3%) the stapler failed due to a thick septum or insufficient reclination of the head. Follow up endoscopy was performed after an average of two months in 9 patients; 4 patients (44.4%) were free of symptoms, 5 patients (55.6%) stated an improvement. A relapse of symptoms did not occur.CONCLUSIONFlexible endoscopic Zenker diverticulotomy by using a surgical stapler is a new, safe and efficient treatment modality. A simultaneously tissue opening and occlusion prevents major complications.

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Section: Discussionmentioning

confidence: 99%

New flexible endoscopic controlled stapler technique for the treatment of Zenker's diverticulum: A case series

Wilmsen

Baumbach

Stüker

et al. 2017

WJG

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“…Submucosal tunneling endoscopic septum division (STESD) is a technique that has most recently been inspired by peroral endoscopic myotomy (POEM) (Fig. ) . This cutting‐edge technique obviates direct dissection of the CP septum and, instead, involves dissecting a submucosal tunnel around the septum to achieve a complete myotomy.…”

Section: Incision Techniquesmentioning

confidence: 99%

“…Theoretically, STESD is associated with reduced risk of perforation and mediastinitis as the esophageal mucosa is sealed with clips, as well as reduced recurrence rates. Efficacy for STESD is still confined to case reports . Its mainstream application is restricted by lack of evidence, and expertise in POEM.…”

Section: Incision Techniquesmentioning

confidence: 99%

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New and emerging techniques for endoscopic treatment of Zenker's diverticulum: State‐of‐the‐art review

Ishaq

Sultan

Siau

et al. 2018

Digestive Endoscopy

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Zenker's diverticulum (ZD), or pharyngeal pouch, is an anatomical defect characterized by herniation of the posterior pharyngeal wall through Killian's dehiscence, and may result in dysphagia and regurgitation. Multiple therapeutic modalities including surgery, rigid and flexible endoscopy have been developed to manage ZD. Although surgical management with open and endoscopically assisted techniques have historically been the mainstay of ZD treatment, minimally invasive flexible endoscopic techniques, carried out under conscious sedation, are increasingly favored. Over the last two decades, the advent of new accessories and techniques have changed the landscape of endotherapy for ZD, with the current armamentarium including, but not limited to, endoscopic stapling, CO laser, argon plasma coagulation, needle knife, bipolar forceps, hook knife, clutch cutter, stag beetle knife, and submucosal tunneling endoscopic septum division. We hereby review the latest evidence to support the endoscopic management of ZD.

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“…Li et al . reported an innovative technique for treating ZD, which they called submucosal tunneling endoscopic septum division (STESD) that takes advantage of POEM. Like POEM, the STESD procedure includes four steps: mucosal incision, submucosal tunneling, the incision of muscular fibers (the septum) and mucosal closure.…”

Section: Zdmentioning

confidence: 99%

POEM for special patient cohorts: A review

Zhang

et al. 2017

J of Digest Diseases

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Peroral endoscopic myotomy (POEM) is a natural orifice, translumenal endoscopic surgical procedure that achieves endoscopic myotomy by conducting a submucosal tunnel as an operating space. It is conventionally performed in achalasia. Recently, several centers worldwide have reported the feasibility of this procedure not only in early achalasia but also in other particular patient cohorts. Possible indications for POEM include previously failed Heller myotomy, pneumatic balloon dilatation or POEM, sigmoid achalasia, pediatric patients, spastic esophagus disorders, Zenker's diverticulum and gastroparesis. However, its application in large numbers of special patient groups awaits knowledge of the long-term outcome and greater experience with POEM.

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Submucosal Tunneling Endoscopic Septum Division: A Novel Technique for Treating Zenker's Diverticulum

Cited by 135 publications

References 4 publications

New flexible endoscopic controlled stapler technique for the treatment of Zenker's diverticulum: A case series

New flexible endoscopic controlled stapler technique for the treatment of Zenker's diverticulum: A case series

New and emerging techniques for endoscopic treatment of Zenker's diverticulum: State‐of‐the‐art review

POEM for special patient cohorts: A review

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