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

World Journal of Gastroenterology 2017年第17期23卷 3084-3091页

作者： Johanna Wilmsen Robert Baumbach Dietmar Stüker Vincens Weingart Frank Neser Stefan Karl Golder Christof Pfundstein Ellen Claudia Notzel Thomas Rosch Siegbert Faiss Department of Gastroenterology and Interventional Endoscopy Asklepios Hospital BarmbekSemmelweis UniversityMedical Faculty Department of Interdisciplinary Endoscopy University Medical Center Tübingen Department of Internal Medicine Garmisch-Partenkirchen Medical Center Department of Internal Medicine II Hospital Chemnitz Department of Internal Medicine III Private Practice for Internal Medicine and Gastroenterology Department of Internal Medicine and Gastroenterology Sana Hospital Lichtenberg Department of Interdisciplinary Endoscopy University Medical Center Hamburg-Eppendorf

AIMTo report about the combination and advantages of a stapler-assisted diverticulotomy performed by flexible *** 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 *** 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 *** 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.

关键词： Zenker’s diverticulum flexible endoscopic treatment Stapler technique Overtube Surgical stapler

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