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Войти в исследования VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy · 2025
Zenker's peroral endoscopic myotomy with myomectomy and ablation: a minimally invasive and effective technique for Zenker's diverticulum resolution.
СтатьяНазвание и аннотация: Перевод в очереди
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Hernández Mondragón Oscar Victor, Pintor Belmontes Kevin Josue
Аннотация
BACKGROUND AND AIMS: Zenker's peroral endoscopic myotomy (Z-POEM) for Zenker's diverticulum is an effective first-line treatment; however, residual dysphagia may persist because of a remaining mucosal pouch. Currently, no standardized endoscopic method specifically addresses this issue. We present a novel approach: Z-POEM with adjunctive myomectomy and mucosal ablation (Z-POEM-MA), designed to achieve complete anatomical resolution in a single session.
METHODS: A 67-year-old man with progressive dysphagia and recurrent aspiration pneumonia was found to have a 4-cm Zenker's diverticulum. He underwent Z-POEM-MA, which included standard submucosal tunneling and cricopharyngeal myotomy, followed by myomectomy using a polypectomy snare, and subsequent mucosal ablation with argon plasma coagulation.
RESULTS: The procedure lasted 46 minutes with no adverse events. The patient resumed oral intake within 48 hours. Postoperative barium esophagram 1 month postoperatively showed complete resolution of the diverticulum. At 6 months, the patient remained asymptomatic, and upper endoscopy confirmed the absence of recurrence.
CONCLUSIONS: Z-POEM-MA is a feasible, safe, and potentially more effective technique compared with conventional Z-POEM, which targets both the muscular and mucosal components of Zenker's diverticulum. This approach may improve outcomes in patients with large pouches. Further studies are warranted to validate its long-term efficacy and reproducibility.
METHODS: A 67-year-old man with progressive dysphagia and recurrent aspiration pneumonia was found to have a 4-cm Zenker's diverticulum. He underwent Z-POEM-MA, which included standard submucosal tunneling and cricopharyngeal myotomy, followed by myomectomy using a polypectomy snare, and subsequent mucosal ablation with argon plasma coagulation.
RESULTS: The procedure lasted 46 minutes with no adverse events. The patient resumed oral intake within 48 hours. Postoperative barium esophagram 1 month postoperatively showed complete resolution of the diverticulum. At 6 months, the patient remained asymptomatic, and upper endoscopy confirmed the absence of recurrence.
CONCLUSIONS: Z-POEM-MA is a feasible, safe, and potentially more effective technique compared with conventional Z-POEM, which targets both the muscular and mucosal components of Zenker's diverticulum. This approach may improve outcomes in patients with large pouches. Further studies are warranted to validate its long-term efficacy and reproducibility.