P90 TRACTION ON THE SEPTUM DURING TRANSORAL SEPTOTOMY FOR ZENKER DIVERTICULUM IMPROVES THE FINAL OUTCOME. (23rd November 2019)

• Record Type: Journal Article
• Authors: Provenzano, L; Salvador, R; Cutrone, C; Moletta, L; Pierobon, E; Nicoletti, L; Capovilla, G; Valmasoni, M; Merigliano, S; Costantini, M
• Is Part Of: Diseases of the esophagus. Volume 32(2019)Supplement 2
• Publication Date: 2019-11-23
• Subjects: Esophagus -- Diseases -- Periodicals; 616.32
• DOI: 10.1093/dote/doz092.90
• Languages: English
• ISSNs: 1120-8694

Abstract

Abstract: Background: Transoral Diverticulostomy/Septotomy has become a popular treatment for patients with Zenker Diverticulum (ZD) because of the low complication rates, reduced procedure time, and shorter hospital stay. However, the outcome of this procedure is not, so far, as positive as the open techniques. In order to improve the results of transoral septotomy (TS), a modification of the technique by tractioning the septum with stiches, has been introduced. In this study we aimed to compare the final outcome of a Modify Transoral Septotomy (MTS) with those of the Traditional Transoral Septotomy (TTS) in patients with ZD. Methods: Seventy-seven consecutive patients with ZD underwent Transoral Septotomy between 2010-2019. Patients who had already been treated with surgical or endoscopic procedures were excluded. TTS was performed with the classic technique. Since 2015, we adopted a MTS, by positioning 2 sutures at the lateral edges of the septum, for traction. Symptoms were collected and scored using a detailed questionnaire; barium-swallow (to assess the size of the pouch), endoscopy and manometry were performed before and after surgical treatment. Failures were defined when a patient needed an additional procedure for recurrent symptoms. Results: Of the 52 patients representing the study population (M:F=49:28), 25 had TTS and 52 had MTS. The patients' demographic and clinical parameters (sex, age, symptom-score, duration of symptoms, diverticulum size) were similar in both groups. Only two intraoperative mucosal lesions were detected and mortality was nil. The median time of the procedure was 25 min (IQR:22-35) in the TTS and 30 min (IQR:25-36) in the MTS (p<0.07). The median follow-up was 85 months in the TTS and 24 months in the MTS. All the patients in both groups had a reduction in the symptom score after the procedure but the failure rate was 32% (8/25) in the TTS and 1.9% (1/52) in the MTS (p<0.01). At the univariate and multivariate analyses, the surgical procedure was the only factor predictive of a positive final result. Conclusions: Transoral Septotomy improves the final outcome of this treatment in patients with ZD.