Background and Aims

Incision of the cricopharyngeal (CP) muscle with flexible endoscopy is an important approach for Zenker diverticulum (ZD) repair with symptomatic resolution in approximately 90% of cases, but recurrence has been reported in up to 20%. We report our experience with a new endoscopic myectomy of the CP muscle and compare the outcome with conventional myotomy of ZD.

Methods

Our retrospective study included all patients with ZD who underwent endoscopic repair between August 1, 2014 and July 31, 2017. Conventional CP myotomy was defined as a vertical cut through the CP muscle. CP myectomy was defined as parallel excisions followed by snare resection at the CP resection base. Measurement of ZD size was based on barium esophagram and endoscopic estimation. Outcomes included ZD recurrence, improvement of dysphagia, and procedure adverse events.

Results

Sixty-four patients underwent endoscopic repair for ZD, 44 with CP myotomy and 20 with CP myectomy. Mean (standard deviation) size of ZD was 3.3 cm (1.0) and 3.8 cm (1.2) in the myotomy and myectomy cohorts, respectively (P = .11), and median procedure time was 50 and 56 minutes, respectively (P = .73). In the CP myotomy cohort, 10 patients (22.7%) had recurrence of ZD at a median of 19.1 months, whereas no recurrence was documented in the CP myectomy cohort (P = .02). This trend was also shown in multivariate analysis but was not statistically significant (P = .07). There was no statistical difference in improvement of dysphagia and adverse events.

Conclusions

CP myectomy is a new endoscopic technique for ZD repair. In our experience, it was safe and well tolerated, with a high initial success rate and less ZD recurrence when compared with myotomy.

中文翻译：

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柔性内镜下咽咽肌切除术和肌切开术修复Zenker憩室的比较

背景和目标

柔性内窥镜切开咽咽（CP）肌肉是有症状消退的Zenker憩室（ZD）修复的一种重要方法，但据报道复发率高达20％。我们报告了新的内镜下CP肌内镜肌切除术的经验，并将其与常规ZD肌切开术进行了比较。

方法

我们的回顾性研究纳入了所有在2014年8月1日至2017年7月31日之间接受内窥镜修复的ZD患者。常规CP肌切开术定义为垂直切开CP肌肉。CP肌切除术定义为平行切除，然后在CP切除基部进行网罗切除。ZD大小的测量基于钡盐食管造影和内窥镜评估。结果包括ZD复发，吞咽困难改善和手术不良事件。

结果

64例患者接受了ZD内镜修复，CP肌切开术44例，CP肌切开术20例。在肌切开术和肌切除术队列中，ZD的平均大小（标准差）分别为3.3厘米（1.0）和3.8厘米（1.2）（P  = .11），中位手术时间分别为50分钟和56分钟（P  =。 73）。在CP肌切开术队列中，有10例患者（22.7％）ZD复发的中位数为19.1个月，而CP肌切开术队列中未发现复发（P  = .02）。这种趋势也显示在多变量分析中，但无统计学意义（P  = .07）。吞咽困难和不良事件的改善无统计学差异。

结论

CP肌瘤切除术是ZD修复的一种新的内窥镜技术。根据我们的经验，与肌切开术相比，它安全且耐受性好，初始成功率高，ZD复发少。