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Surgical Endoscopy Sep 2023Flexible endoscopic therapy of Zenker's diverticulum using submucosal tunneling (Z-POEM) similar to esophageal Per-Oral Endoscopic Myotomy (POEM) is becoming...
Comparison of Zenker's per-oral endoscopic myotomy (Z-POEM) with standard flexible endoscopic septotomy for Zenker's diverticulum: a prospective study with 2-year follow-up.
BACKGROUND
Flexible endoscopic therapy of Zenker's diverticulum using submucosal tunneling (Z-POEM) similar to esophageal Per-Oral Endoscopic Myotomy (POEM) is becoming increasingly common. However, data comparing Z-POEM with traditional flexible endoscopic septotomy (FES) are sparse. The aim of this study was to compare outcomes of Z-POEM with traditional FES over a medium-term follow-up period.
METHODS
This was a prospective study of patients who underwent Z-POEM for treatment of Zenker's diverticulum between 2018 and 2020 at a tertiary academic medical center compared to prior patients who had FES (between 2015 and 2018). Procedural characteristics and clinical outcomes (technical and clinical success, and adverse events) were compared between patients who underwent each treatment.
RESULTS
A total of 28 patients underwent ZD therapy during the study period. 13 patients (mean age 70 years; 77% male) underwent Z-POEM and 15 patients (mean age 72 years; 73% male) underwent traditional FES. The mean Zenker's diverticulum size was 2.4 ± 0.6 cm in the ZPOEM group vs 2.5 ± 0.8 cm in the FES group. The mean procedure time was similar between groups: 43.9 min (range 26-66) in the Z-POEM group and 60.2 min (range 25-92) in the traditional FES group (t = 1.74 p = 0.19). Overall technical success was seen in 100% of patients. There was one adverse event in the FES group (dehydration resulting in near-syncope) (1/28, 3.6%). Overall clinical success was seen in 92.8% (26/28) of patients and was not significantly different between groups (Z-POEM; 13/13, 100% vs FES; 13/15, 86.7%, t = - 1.36 p = 0.18).
CONCLUSION
This prospective study suggests that ZPOEM is an effective technique for the treatment of Zenker's diverticulum with no significant differences in clinical outcomes or adverse event rates when compared to traditional FES.
Topics: Humans; Male; Aged; Female; Zenker Diverticulum; Prospective Studies; Follow-Up Studies; Treatment Outcome; Myotomy; Esophagoscopy
PubMed: 37277515
DOI: 10.1007/s00464-023-10136-4 -
Medicina (Kaunas, Lithuania) Nov 2023Diverticulosis is frequently accompanied by altered bowel habits. The biogenic amines within colonic mucosa control bowel motility, and in particular, alterations in...
Diverticulosis is frequently accompanied by altered bowel habits. The biogenic amines within colonic mucosa control bowel motility, and in particular, alterations in serotonin signaling may play a role in colon diverticulosis. The aim of the study was to assess the concentration of biogenic amines and serotonin receptor expression in the colonic mucosa in patients with diverticulosis and healthy controls. This prospective, comparative study included 59 individuals: 35 with sigmoid diverticulosis and 24 healthy controls. The study was held at the Department of Gastroenterology and Internal Medicine, Medical University of Warsaw, Poland. Mucosal samples were taken from the right and left colon during a colonoscopy in all patients. Concentrations of norepinephrine, 3-methoxy-4-hydroxyphenylglycol, dopamine, homovanillic acid, serotonin, and 5hydroxyindoleacetic acid were measured with high-performance liquid chromatography. Expressions of human 5-hydroxytryptamine receptor 3A, 5-hydroxytryptamine receptor 4, 5-hydroxytryptamine receptor 7, solute carrier family 6 member 4 (SERT) for serotonin, as well as the neuroglia activation markers glial fibrillary acidic protein, S100 calcium-binding protein B, and proteolipid protein 1, were assessed with polymerase chain reaction. The median age and sex distribution were comparable in both study groups (median 69 y vs. 52 y; < 0.455 and males/females in cases 11/17 vs. 18/19 in controls; < 0.309). In diverticulosis patients, there was a higher concentration of serotonin in the left affected colon compared to the right healthy part of the colon (median 8239 pg/mg vs. 6326 pg/mL; < 0.01). The expression was lower in the affected left segment compared to the right colon (median 0.88 vs. 1.36; < 0.01). There was a higher colonic mucosa concentration of serotonin (median 8239 pg/mg vs. 6000 pg/mL; < 0.02) and 5hydroxyindoleacetic acid/serotonin ratio (median 0.27 vs. 0.47; < 0.01) in diverticulosis patients compared to controls in the left side of the colon. The concentration of serotonin in the mucosa of the colon segment affected by diverticula is higher than in the healthy segment in the same individuals and higher than in healthy controls. These results underline serotonin signaling in colon diverticulosis pathophysiology.
Topics: Humans; Male; Female; Serotonin; Prospective Studies; Hydroxyindoleacetic Acid; Colon; Receptors, Serotonin; Diverticulum
PubMed: 38003994
DOI: 10.3390/medicina59111945 -
The Journal of Thoracic and... Jun 2022
Topics: Humans; Surgical Stapling; Zenker Diverticulum
PubMed: 33610357
DOI: 10.1016/j.jtcvs.2021.01.026 -
Vascular and Endovascular Surgery Nov 2023Kommerell's diverticulum (KD) with a right aortic arch (RAA) and aberrant left subclavian artery (aLSCA) is a rare congenital anomaly of the aortic arch. Treatment is...
BACKGROUND
Kommerell's diverticulum (KD) with a right aortic arch (RAA) and aberrant left subclavian artery (aLSCA) is a rare congenital anomaly of the aortic arch. Treatment is not well defined due to its uncommon presentation, with rupture and dissection risk rates of up to 53%.
CASE SUMMARY
A 54-year-old male with a history of chronic obstructive pulmonary disease (COPD) and hypertension presented with difficulty breathing during exercise without dysphagia. Follow-up computerized tomography angiogram (CTA) revealed the presence of a RAA and aLSCA arising from the descending thoracic aorta with an adjacent 58 × 41-mm KD and tracheal and esophageal displacement. Due to the size of the KD, risk of rupture, unsuitable anatomy for total endovascular aortic repair (EVAR), and high COPD burden, the patient was planned to undergo a hybrid surgical repair. Left common carotid (LCCA) artery to LSCA bypass, full aortic debranching, LSCA embolization and percutaneous thoracic endovascular aortic repair (TEVAR) were performed. Successful device position and exclusion of the diverticulum and aneurysmal aorta were observed after completion thoracic aortogram. 18-month follow-up CTA demonstrated patency of the LSCA to LCCA bypass graft and arch vessel branches, as well as stable exclusion of the KD. Persistence of a type II endoleak originated at the right first posterior intercostal artery has been noted and is being followed conservatively since no sac growth has occurred.
CONCLUSION
We highlight the presence of a KD with RAA and aberrant subclavian artery, a rare congenital anatomic variation of the aortic arch with complex anatomy. Surgical planning must be individualized according to comorbidities and anatomical variations identified on imaging and 3D reconstructions.
Topics: Male; Humans; Middle Aged; Aorta, Thoracic; Treatment Outcome; Cardiovascular Abnormalities; Subclavian Artery; Aortography; Pulmonary Disease, Chronic Obstructive; Diverticulum
PubMed: 37310394
DOI: 10.1177/15385744231183310 -
BMC Gastroenterology Aug 2021Zenker's diverticulum (ZD) is an uncommon disorder due to an outpouching of tissue through the Killian triangle that is thought to be caused by dysfunction of the...
BACKGROUND
Zenker's diverticulum (ZD) is an uncommon disorder due to an outpouching of tissue through the Killian triangle that is thought to be caused by dysfunction of the cricopharyngeal muscle.
CASE PRESENTATION
An 85-year-old male patient presented with odynophagia and dysphagia of initially solid food followed by fluids that was associated with a significant weight loss over a one-year period. Barium swallow videofluoroscopy demonstrated a posterior outpouching of proximal esophagus that was 2 cm from the epiglottis. With the diagnosis of medium sized ZD, the patient underwent endoscopy guided diverticulotomy. Six months after the procedure, he was asymptomatic and had gained weight.
CONCLUSIONS
Dysphagia and weight loss raises a clinical suspicion for a malignancy. Barium swallow examination is an inexpensive method for the diagnosis of ZD.
Topics: Aged, 80 and over; Deglutition Disorders; Endoscopy; Humans; Male; Uganda; Zenker Diverticulum
PubMed: 34461856
DOI: 10.1186/s12876-021-01914-2 -
BMC Women's Health Aug 2023A uterine diverticulum is defined as the presence of a niche within the inner contour of the uterine myometrial wall. Although secondary uterine diverticula can occur...
BACKGROUND
A uterine diverticulum is defined as the presence of a niche within the inner contour of the uterine myometrial wall. Although secondary uterine diverticula can occur after hysterotomy such as cesarean section, reports of diverticula after myomectomy are extremely rare.
CASE PRESENTATION
A 45-year-old nulliparous woman undergoing infertility treatment was referred to our hospital because of abnormal postmenstrual bleeding after myomectomy. Transvaginal sonography and magnetic resonance imaging revealed a diverticulum in the isthmus. Fat-saturated T1 image showed a blood reservoir in the diverticulum. Hysteroscopic surgery was performed to remove the lowed edge of the defect and coagulate the hypervascularized area. Two months after surgery, the abnormal postmenstrual bleeding and chronic endometritis improved.
DISCUSSION AND CONCLUSIONS
This report highlights the similarities of the patient's diverticulum to cesarean scar defects in terms of symptoms and pathophysiology. First, this patient developed a diverticulum with hypervascularity after myomectomy and persistent abnormal bleeding. Second, after hysteroscopic surgery, the symptoms of irregular bleeding disappeared. Third, endometrial glands were identified within the resected scar tissue. Fourth, preoperatively identified CD138-positive cells in endometrial tissue spontaneously disappeared after hysteroscopic resection. To the best of our knowledge, this is the first report of symptomatic improvement following hysteroscopic surgery in a patient with an iatrogenic uterine diverticulum with persistent irregular bleeding after myomectomy.
Topics: Pregnancy; Humans; Female; Middle Aged; Uterine Myomectomy; Cesarean Section; Cicatrix; Uterus; Diverticulum
PubMed: 37641054
DOI: 10.1186/s12905-023-02606-7 -
PloS One 2019Diverticulosis and colorectal neoplasia share epidemiological trends and risk factors which are common in Western countries and incidences increase with age. However,... (Meta-Analysis)
Meta-Analysis
BACKGROUND/AIMS
Diverticulosis and colorectal neoplasia share epidemiological trends and risk factors which are common in Western countries and incidences increase with age. However, the data on an association between diverticulosis and colorectal neoplasia are conflicting. Thus, we performed a meta-analysis to evaluate whether diverticulosis is associated with colorectal neoplasia.
METHODS
A systematic literature search of PubMed, EMBASE, Cochrane Library, Web of Science, and SCOPUS was conducted to identify studies that investigated the association between diverticulosis and advanced colorectal neoplasia (advanced adenoma, colorectal cancer), adenomas, or polyps. The demographic characteristics of patients, including age, gender, indication for colonoscopy, confounding factors, and outcomes of colorectal neoplasia were assessed.
RESULTS
We identified 29 cross-sectional studies (N = 450,953) that investigated the association between diverticulosis and colorectal neoplasia. The meta-analysis found that diverticulosis was not associated with advanced colorectal neoplasia (odds ratio [OR] 0.98, 95% confidence interval [CI] 0.63-1.50). Although there was a positive correlation between diverticulosis and adenomas (OR 1.47, 95% CI 1.18-1.84) and diverticulosis and polyps (OR 1.95, 95% CI 1.15-3.31), diverticulosis did not increase the risk of adenomas (OR 1.34, 95% CI 0.87-2.06) in patients who underwent screening colonoscopy. Moreover, all the increased risk of colorectal neoplasia in patients with diverticulosis was observed in published studies only, and not in unpublished ones.
CONCLUSIONS
This meta-analysis demonstrated that diverticulosis is not associated with an increased risk of advanced colorectal neoplasia. Although diverticulosis was associated with a higher risk of polyps and adenomas, the risk was not increased in screening populations. Moreover, the increased risk of colorectal neoplasia in patients with diverticulosis was observed only in published studies and not in unpublished ones.
Topics: Aged; Colonoscopy; Colorectal Neoplasms; Diverticulum; Female; Humans; Incidence; Middle Aged; Risk Factors
PubMed: 31141507
DOI: 10.1371/journal.pone.0216380 -
Journal of the American Veterinary... Dec 2017CASE DESCRIPTION A 5-year-old sexually intact female guinea pig was evaluated because of mild dysuria and a subcutaneous mass located cranioventral to the urogenital...
CASE DESCRIPTION A 5-year-old sexually intact female guinea pig was evaluated because of mild dysuria and a subcutaneous mass located cranioventral to the urogenital openings. CLINICAL FINDINGS Non-contrast-enhanced CT and surgical exploration of the distal aspect of the urethra revealed a urethral diverticulum with an intraluminal urolith. Analysis revealed that the urolith was composed of calcium carbonate and struvite. TREATMENT AND OUTCOME The urolith was surgically removed and ablation of the urethral diverticulum was attempted. Approximately 3 months later, the guinea pig was reevaluated for masses in the perineal region, and positive-contrast urethrocystography revealed 2 uroliths present in the same diverticulum. Uroliths were manually expressed with the patient under general anesthesia. Approximately 2 weeks later, urethroplasty was performed to create an enlarged stoma with the diverticulum, thereby preventing urine from pooling in the diverticulum and potentially reducing the risk of future urolith formation. The urethroplasty site healed well with no reported complications or evidence of urolith recurrence 6 months after surgery. CLINICAL RELEVANCE Urolithiasis is common in guinea pigs, and urethral diverticulum and intraluminal urolith formation should be considered as a potential differential diagnosis for a subcutaneous mass along the distal aspect of the urethra. Creation of a urethral stoma from a urethral diverticulum via urethroplasty achieved a successful outcome in this patient.
Topics: Animals; Diagnosis, Differential; Diverticulum; Female; Guinea Pigs; Rodent Diseases; Tomography, X-Ray Computed; Urethral Diseases; Urolithiasis; Urologic Surgical Procedures
PubMed: 29154708
DOI: 10.2460/javma.251.11.1313 -
Ultrasound in Obstetrics & Gynecology :... Jun 2023
Topics: Pregnancy; Female; Humans; Heart Defects, Congenital; Prenatal Diagnosis; Diverticulum; Heart Ventricles
PubMed: 36484455
DOI: 10.1002/uog.26137 -
Journal of Vascular Surgery May 2021The analysis of endovascular treatment of thoracic aortic diseases using new low-profile stent grafts in large series is crucial to understanding the durability of these...
OBJECTIVE
The analysis of endovascular treatment of thoracic aortic diseases using new low-profile stent grafts in large series is crucial to understanding the durability of these devices. The present study reports the midterm outcomes of a single-center experience using the Zenith Alpha thoracic endovascular stent graft.
METHODS
The outcomes of 270 procedures performed on 262 patients (197 men; mean age, 70.5 ± 9.5 years) using the Zenith Alpha thoracic endovascular stent graft from November 2013 to December 2019 for different thoracic aortic diseases were analyzed. The primary endpoints were 30-day clinical success and midterm (5-year) clinical success. The secondary endpoints were the adverse event rate at 30 days and midterm and access- and device-related complications. The follow-up of surviving patients was performed using computed tomography angiography and office visits at 1, 6, and 12 months and annually thereafter. Kaplan-Meier analysis was performed for overall survival, and freedom from thoracic aortic endovascular repair-related mortality and related reinterventions.
RESULTS
The overall 30-day mortality was 5.2% (2.5% for elective and 30.8% for nonelective cases). Type I endoleaks were identified in six patients. The 30-day primary technical and clinical success rates were 97.8% and 92.6%, respectively. Femoral cutdown was used in 41.1% of cases and percutaneous access in 58.5%. The rate of femoral artery complications after the percutaneous approach was 5.1%, with the need for surgical conversion in 1.9%. The stroke rate was 4.1% (major stroke, 2.2%), and the spinal cord ischemia rate was 3.7% (permanent paraplegia, 0.7%). Of the 248 survivors, 239 complied with the follow-up protocol with adequate computed tomography angiograms available images. Overall follow-up survival was 94.0% at 1 year, 91.6% at 2 years, 88.9% at 3 years, and 88.5% at 5 years. The unplanned secondary endovascular procedure rate was 5.3%. No stent fractures or new-onset type I endoleaks due to stent graft migration were observed in the study cohort.
CONCLUSIONS
The midterm outcomes of this new generation of low-profile devices were satisfactory. The reported low incidence of secondary procedures and the absence of migrations are promising for the long-term durability of these devices.
Topics: Aged; Aorta, Thoracic; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Databases, Factual; Diverticulum; Endovascular Procedures; Humans; Italy; Male; Middle Aged; Postoperative Complications; Prosthesis Design; Reoperation; Retrospective Studies; Risk Factors; Stents; Time Factors; Treatment Outcome
PubMed: 33065242
DOI: 10.1016/j.jvs.2020.10.003