Post written by Ping-Hong Zhou, MD, FASGE, from the Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, and Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China.
In this study, we primarily focused on the safety and efficacy of submucosal tunneling endoscopic septum division (STESD) for patients with esophageal diverticulum and STESD’s impact on patients’ quality of life (QOL).
Although esophageal diverticulum is a benign disease, patients’ QOL is relatively poor. Open surgery, including myotomy and diverticulectomy, is the traditional approach to esophageal diverticulum treatment, but these techniques are associated with a high risk of adverse events, including perforation, wound infection, and mediastinitis.
STESD is an endoscopic minimally invasive intervention for esophageal diverticulum. A submucosal tunnel is created before incision of the septum of the diverticulum in the tunnel, preserving the integrity of the mucosa. Thus, this technique could greatly lower the risk of serious adverse events, such as perforation and mediastinal inflammation.
STESD’s effectiveness and safety have been verified in several short-term studies and case reports. However, the duration of follow-up in these studies was <1 year. The medium- and long-term efficacy of this technique should be fully evaluated.
Therefore, this study was conducted. We also used the 36-item Short Form survey (SF-36) to evaluate changes in QOL. These results will help symptom evaluation of this technique.
During the procedure, mucosal injury occurred in 2 patients. These injuries were closed immediately using hemostatic clips. No perforation, hemorrhage, or other severe adverse events were observed during surgery, hospitalization, or follow-up. The mean symptom score for patients decreased significantly.
Most patients experienced some improvement in diverticulum depth, but the difference in depth did not reach the traditional level of statistical significance of P < .05. We think this is a topic worthy of further discussion.
The mean total SF-36 score increased significantly at 1 year after surgery, meaning QOL improved, especially in the areas of general health, vitality, social functioning, and mental health. Future large-scale prospective studies are necessary to fully evaluate this technique.
Submucosal tunneling endoscopic septum division procedures. A, A diverticulum 30 cm from the incisors. B, Clear exposure of the muscle fibers of the septum in the submucosal tunnel. C, Completion of the myotomy. D, Closure of the tunnel entry. AD, Diverticulum lumen; AE, esophageal lumen.
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