RESUMEN
AIM: To report about the combination and advantages of a stapler-assisted diverticulotomy performed by flexible endoscopy. METHODS: From 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 control. RESULTS: In 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 occur. CONCLUSION: Flexible 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.
Asunto(s)
Esofagoscopía/métodos , Engrapadoras Quirúrgicas , Grapado Quirúrgico/métodos , Divertículo de Zenker/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Esofagoscopía/efectos adversos , Esofagoscopía/instrumentación , Esófago/diagnóstico por imagen , Esófago/cirugía , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Grapado Quirúrgico/efectos adversos , Grapado Quirúrgico/instrumentación , Resultado del Tratamiento , Divertículo de Zenker/diagnóstico por imagenRESUMEN
Acute gastrointestinal bleeding is a common major emergency (Internal medical or gastroenterological or medical), approximately 85 % of which occur in the upper GI tract. It is estimated that about a half of upper GI bleeds are caused by peptic ulcers. Upper GI bleeds are associated with more severe bleeding and poorer outcomes when compared to middle or lower GI bleeds. Prognostic determinants include bleeding intensity, patient age, comorbid conditions and the concomitant use of anticoagulants. A focused medical history can offer insight into the bleeding intensity, location and potential cause (along with early risk stratification). Initial measures should focus on rapid assessment and resuscitation of unstable patients. The oesophagogastroduodenoscopy (OGD) is the gold standard method for localizing the source of bleeding and for interventional therapy. Bleeding as a result of peptic ulcers is treated endoscopically with mechanical and / or thermal techniques in combination with proton pump inhibitor (PPI) therapy. When variceal bleeding is suspected, pre-interventional use of vasopressin analogues and antibiotic therapies are recommended. Endoscopically, the first line treatment of esophageal varices is endoscopic ligature therapy, whereas that for gastric varices is the use of Histoacryl injection sclerotherapy. When persistent and continued massive hemorrhage occurs in a patient with known or suspected aortic disease the possibility of an aorto-enteric fistula must be considered.
Asunto(s)
Hemorragia Gastrointestinal , Enfermedad Aguda , Femenino , Humanos , Persona de Mediana EdadRESUMEN
OBJECTIVE: Zenker´s diverticulum (ZD) is a rare cause of dysphagia. Various surgical and flexible endoscopic therapies are available with either higher morbidity or either higher recurrence rate. Therefore, improved treatment options are needed. MATERIAL AND METHODS: This case report involves an 83-year-old female patient with symptomatic ZD. Under flexible endoscopic control, a new 5 mm fully rotatable surgical stapler was used for the dissection of the septum between the ZD and the esophageal lumen. An ultrathin endoscope and the 5 mm stapler were introduced together through a flexible overtube under conscious sedation. RESULTS: ZD treatment with this new stapler technique was feasible and effective in our patient. Procedure time was 10 min. Clinical symptoms improved immediately and the patient could be discharged the day after the procedure. CONCLUSION: The described stapler technique under flexible endoscopic control is the first report of this new treatment option for ZD. This new technique under conscious sedation may have some potential advantages compared to standard techniques such as better long-term results and lower complication rates. Further studies are needed.