Counter mucosal incision with Zenker's peroral endoscopic myotomy: an innovative approach for mucosal decompression in Zenker’s diverticulum and mucosal webs

Q3 Medicine

VideoGIE Pub Date : 2025-05-02 DOI:10.1016/j.vgie.2025.04.011

Boldbaatar Gantuya MD, PhD , Haruhiro Inoue MD, PhD , Kazuki Yamamoto MD, PhD , Ippei Tanaka MD , Yohei Nishikawa MD , Kei Ushikubo MD , Mayo Tanabe MD

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引用次数: 0

Abstract

Background and Aims

Zenker’s diverticulum (ZD) is a pouch of the mucosa arising from the Killian triangle. Any size of symptomatic ZD or medium to large (2-3 cm or more) ZD needs intervention. Zenker's peroral endoscopic myotomy (Z-POEM) is the ideal first-line therapy for making the reliable myotomy. We aimed to demonstrate the latest Z-POEM techniques and counter mucosal incision (CMI) for a patient with larger-sized ZD and pre-existing esophageal mucosal webs near ZD.

Methods

The CMI technique recently was developed by our hospital for antireflux intervention. It is a novel tension-relief technique of the mucosal plasty for enhancing closure stability. This time we performed esophageal mucosal incision on the opposite side of the Z-POEM defect closure part to relieve the mucosal tension and alleviate a postoperative stricture resulting from the tight clip closure in the background of the stiff surrounding mucosa and webs near the ZD.

Results

We obtained complete eradication of ZD pouch without creating a stricture.

Conclusions

CMI is the ideal approach for preventing a stricture related to the use of tight clip closure of the Z-POEM for a larger-sized ZD with a background of the surrounding mucosal webs.

查看原文本刊更多论文

反粘膜切口与Zenker的经口内窥镜肌切开术：在Zenker憩室和粘膜网中进行粘膜减压的一种创新方法

背景和目的zenker憩室（ZD）是起源于基连三角的粘膜袋。任何大小的症状性ZD或中大型（2-3厘米或更多）ZD都需要干预。Zenker的经口内窥镜肌切开术（Z-POEM）是进行可靠的肌切开术的理想一线治疗方法。我们的目的是展示最新的Z-POEM技术和反粘膜切口（CMI），用于治疗较大的ZD和ZD附近已有的食管粘膜网。方法CMI技术是我院新近开发的抗反流干预技术。这是一种新型的缓解张力的粘膜成形术，以提高闭合稳定性。本次我们在Z-POEM缺损闭合部位的对侧进行食管粘膜切口，以缓解黏膜张力，缓解在ZD附近僵硬的周围粘膜和腹网背景下夹紧闭合造成的术后狭窄。结果完全根除了ZD眼袋，没有造成狭窄。结论scmi是防止与使用紧夹关闭Z-POEM相关的狭窄的理想方法，用于具有周围粘膜网背景的较大ZD。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

VideoGIE Medicine-Gastroenterology

CiteScore

1.50

自引率

0.00%

发文量

132

审稿时长

105 days

期刊介绍： VideoGIE, an official video journal of the American Society for Gastrointestinal Endoscopy, is an Open Access, online-only journal to serve patients with digestive diseases. VideoGIE publishes original, single-blinded peer-reviewed video case reports and case series of endoscopic procedures used in the study, diagnosis, and treatment of digestive diseases. Videos demonstrate use of endoscopic systems, devices, and techniques; report outcomes of endoscopic interventions; and educate physicians and patients about gastrointestinal endoscopy. VideoGIE serves the educational needs of endoscopists in training as well as advanced endoscopists, endoscopy staff and industry, and patients. VideoGIE brings video commentaries from experts, legends, committees, and leadership of the society. Careful adherence to submission guidelines will avoid unnecessary delays, as incomplete submissions may be returned to the authors before initiation of the peer review process.