Esophageal Diverticulum - Indications and Efficacy of Therapeutic Endoscopy.
Esophageal Diverticulum - Indications and Efficacy of Therapeutic Endoscopy.
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DOI：
10.2169/internalmedicine.8196-21
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发表时间：
2022
影响因子：
1.2
通讯作者：
Terai, Shuji
中科院分区：
文献类型：
--
作者：
Sato, Hiroki;Takeuchi, Manabu;Takahashi, Kazuya;Mizuno, Ken-Ichi;Furukawa, Koichi;Sato, Akito;Nakajima, Nao;Yokoyama, Junji;Terai, Shuji
关键词：
食管憩室很少见，在日本还没有研究过伴随有食道动力障碍(EMDS)和新的内窥镜治疗方法的疗效。对同时患有EMDS和膈上皮憩室的患者进行包括高分辨率测压(HRM)在内的检查。对EMD相关的膈上皮憩室和Zenker憩室分别采用经口腔内窥镜下保留肌切开术(S-POEM)和内窥镜下憩室切开术治疗。本文诊断了6例膈上性憩室。在125例失弛缓症和痉挛障碍患者中，4例(3.2%)伴发膈上憩室。其中3例在HRM上显示下食道括约肌压力正常，尽管胃镜和食道摄影显示下食道括约肌松弛受损的典型表现。4例患者均成功应用S-POEM治疗，术后随访32.5(13~56)个月，Ekardt评分由6.3分提高至0.2 5分，疗效与无膈上憩室的失弛缓症及痉挛障碍相当。相比之下，其余两例膈上憩室患者的食道动力正常。诊断为Zenker憩室6例，均成功行鼻内窥镜下憩室切开术。随访14.8(2~36)个月，吞咽困难评分由2.8分降至0.17分。总体而言，对食管憩室进行了12次内窥镜治疗；没有观察到不良事件。在膈上皮憩室患者中，伴发的EMDS并不罕见，应仔细诊断。HRM上正常的下食道括约肌压力并不总是意味着正常的下食道括约肌松弛。S-POE和内窥镜下憩室切开术是治疗EMD相关性膈上憩室和Zenker憩室的有效微创治疗方法。
Esophageal diverticulum is rare, and the concomitance of esophageal motility disorders (EMDs) and the efficacy of novel endoscopic treatment have not been investigated in Japan. An examination including high-resolution manometry (HRM) was performed for patients with both EMDs and epiphrenic diverticulum. EMD-related epiphrenic diverticulum and Zenker's diverticulum were treated using salvage peroral endoscopic myotomy (s-POEM) and endoscopic diverticulotomy, respectively. Six cases of epiphrenic diverticulum were diagnosed in this study. Among 125 patients with achalasia and spastic disorders, concomitant epiphrenic diverticulum was observed in 4 (3.2%). Of these, three showed a normal lower esophageal sphincter pressure on HRM, although gastroscopy and esophagography revealed typical findings of an impaired lower esophageal sphincter relaxation. These four patients were successfully treated with s-POEM, and the Eckardt score improved from 6.3 to 0.25 at 32.5 (range: 13-56) months of follow-up, with equivalent treatment efficacy to that observed for achalasia and spastic disorders without epiphrenic diverticulum. In contrast, the two remaining cases of epiphrenic diverticulum had normal esophageal motility. Six cases of Zenker's diverticulum were diagnosed, and endoscopic diverticulotomy was successfully performed in all. The dysphagia score decreased from 2.8 to 0.17 at 14.8 (range: 2-36) months of follow-up. Overall, 12 endoscopic treatments were performed for esophageal diverticulum; no adverse events were observed. In epiphrenic diverticulum patients, concomitant EMDs are not rare and should be carefully diagnosed. A normal lower esophageal sphincter pressure on HRM does not always mean a normal lower esophageal sphincter relaxation. S-POEM and endoscopic diverticulotomy are effective minimally invasive treatment options for EMD-related epiphrenic diverticulum and Zenker's diverticulum.
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