Yara Sarkis, Sarah Stainko, Anthony Perkins, Mohammad A Al-Haddad, John M DeWitt
{"title":"比较柔性内窥镜针刀隔膜切除术和口周内窥镜肌切开术治疗禅克氏憩室。","authors":"Yara Sarkis, Sarah Stainko, Anthony Perkins, Mohammad A Al-Haddad, John M DeWitt","doi":"10.1016/j.gie.2024.08.035","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and aims: </strong>Treatment of Zenker's diverticulum (ZD) has evolved from flexible endoscopic septotomy (FES) to peroral endoscopic myotomy (Z-POEM). In this study, we compare efficacy and safety of FES with a needle knife septotomy (FENKS) and Z-POEM for symptomatic ZD.</p><p><strong>Methods: </strong>Consecutive patients at a single institution who underwent endoscopic ZD treatment by FENKS or Z-POEM were identified. Demographics, clinical characteristics, procedure technique, technical and clinical success, and adverse events (AEs) within 30 days were reviewed and compared between the two groups. AEs were classified by the AGREE classification. Baseline and post-procedure Dakkak and Bennett's (DB) scores were reported at 6, 12 and 24 months. Clinical success (DB score ≤1) was assessed by per-protocol (PP) and intention-to-treat analyses (ITT).</p><p><strong>Results: </strong>60 patients (55% M, mean 72±12 yrs.) underwent FENKS (n=21) or Z-POEM (n=39) between 2016 and 2023. Baseline clinical characteristics were similar and overall technical success was 98.3%. Clinical success by PP and ITT analyses at 6, 12 and 24 months after intervention were similar between both groups. The FENKS group had a higher prevalence (29% vs. 5%, p=0.018) and severity (p=0.032) of AEs and were more likely to be hospitalized after treatment (71% vs. 33%, p=0.007). During a median follow up of 18 months, reintervention was required for 5 (10%) in the FENKS (n=2, 9%) and Z-POEM (n=3, 7.6%) groups (p=1.0) a mean 7.6 ± 4.4 months after initial therapy.</p><p><strong>Conclusion: </strong>Treatment of ZD with Z-POEM appears to be safer than FENKS with similar short- and mid-term clinical success.</p>","PeriodicalId":12542,"journal":{"name":"Gastrointestinal endoscopy","volume":null,"pages":null},"PeriodicalIF":6.7000,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Comparison of flexible endoscopic needle knife septotomy and peroral endoscopic myotomy for treatment of Zenker's diverticulum.\",\"authors\":\"Yara Sarkis, Sarah Stainko, Anthony Perkins, Mohammad A Al-Haddad, John M DeWitt\",\"doi\":\"10.1016/j.gie.2024.08.035\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and aims: </strong>Treatment of Zenker's diverticulum (ZD) has evolved from flexible endoscopic septotomy (FES) to peroral endoscopic myotomy (Z-POEM). In this study, we compare efficacy and safety of FES with a needle knife septotomy (FENKS) and Z-POEM for symptomatic ZD.</p><p><strong>Methods: </strong>Consecutive patients at a single institution who underwent endoscopic ZD treatment by FENKS or Z-POEM were identified. Demographics, clinical characteristics, procedure technique, technical and clinical success, and adverse events (AEs) within 30 days were reviewed and compared between the two groups. AEs were classified by the AGREE classification. Baseline and post-procedure Dakkak and Bennett's (DB) scores were reported at 6, 12 and 24 months. Clinical success (DB score ≤1) was assessed by per-protocol (PP) and intention-to-treat analyses (ITT).</p><p><strong>Results: </strong>60 patients (55% M, mean 72±12 yrs.) underwent FENKS (n=21) or Z-POEM (n=39) between 2016 and 2023. Baseline clinical characteristics were similar and overall technical success was 98.3%. Clinical success by PP and ITT analyses at 6, 12 and 24 months after intervention were similar between both groups. The FENKS group had a higher prevalence (29% vs. 5%, p=0.018) and severity (p=0.032) of AEs and were more likely to be hospitalized after treatment (71% vs. 33%, p=0.007). During a median follow up of 18 months, reintervention was required for 5 (10%) in the FENKS (n=2, 9%) and Z-POEM (n=3, 7.6%) groups (p=1.0) a mean 7.6 ± 4.4 months after initial therapy.</p><p><strong>Conclusion: </strong>Treatment of ZD with Z-POEM appears to be safer than FENKS with similar short- and mid-term clinical success.</p>\",\"PeriodicalId\":12542,\"journal\":{\"name\":\"Gastrointestinal endoscopy\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":6.7000,\"publicationDate\":\"2024-08-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Gastrointestinal endoscopy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.gie.2024.08.035\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Gastrointestinal endoscopy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.gie.2024.08.035","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
Comparison of flexible endoscopic needle knife septotomy and peroral endoscopic myotomy for treatment of Zenker's diverticulum.
Background and aims: Treatment of Zenker's diverticulum (ZD) has evolved from flexible endoscopic septotomy (FES) to peroral endoscopic myotomy (Z-POEM). In this study, we compare efficacy and safety of FES with a needle knife septotomy (FENKS) and Z-POEM for symptomatic ZD.
Methods: Consecutive patients at a single institution who underwent endoscopic ZD treatment by FENKS or Z-POEM were identified. Demographics, clinical characteristics, procedure technique, technical and clinical success, and adverse events (AEs) within 30 days were reviewed and compared between the two groups. AEs were classified by the AGREE classification. Baseline and post-procedure Dakkak and Bennett's (DB) scores were reported at 6, 12 and 24 months. Clinical success (DB score ≤1) was assessed by per-protocol (PP) and intention-to-treat analyses (ITT).
Results: 60 patients (55% M, mean 72±12 yrs.) underwent FENKS (n=21) or Z-POEM (n=39) between 2016 and 2023. Baseline clinical characteristics were similar and overall technical success was 98.3%. Clinical success by PP and ITT analyses at 6, 12 and 24 months after intervention were similar between both groups. The FENKS group had a higher prevalence (29% vs. 5%, p=0.018) and severity (p=0.032) of AEs and were more likely to be hospitalized after treatment (71% vs. 33%, p=0.007). During a median follow up of 18 months, reintervention was required for 5 (10%) in the FENKS (n=2, 9%) and Z-POEM (n=3, 7.6%) groups (p=1.0) a mean 7.6 ± 4.4 months after initial therapy.
Conclusion: Treatment of ZD with Z-POEM appears to be safer than FENKS with similar short- and mid-term clinical success.
期刊介绍：
Gastrointestinal Endoscopy is a journal publishing original, peer-reviewed articles on endoscopic procedures for studying, diagnosing, and treating digestive diseases. It covers outcomes research, prospective studies, and controlled trials of new endoscopic instruments and treatment methods. The online features include full-text articles, video and audio clips, and MEDLINE links. The journal serves as an international forum for the latest developments in the specialty, offering challenging reports from authorities worldwide. It also publishes abstracts of significant articles from other clinical publications, accompanied by expert commentaries.
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