Per-Oral Endoscopic Septotomy versus Flexible Endoscopy Septotomy for Short-Septum Zenker’s Diverticulum
Notice bibliographique
Résumé
Aims Treatment of short-septum Zenker’s diverticulum (SS-ZD) is challenging because the limited anatomical space restricts operating area and scope maneuverability. Recently, per-oral endoscopic septotomy (POES) has emerged as a third-space method for treating of SS-ZD, providing the immediate access to the cricopharyngeal muscle via a submucosal tunneling approach, and allowing the mucosal flap sparing, which facilitates clip closure after dissection. This study aims to compare the effectiveness and safety of per-oral endoscopic septotomy (POES) with traditional flexible endoscopic septotomy (FES) for the treatment of symptomatic patients with SS-ZD. Methods All consecutive patients with symptomatic SS-ZD treated by FES (from 2015 to 2018) and POES (from 2019 to 2022) at a high-volume advance therapeutic endoscopy center were included. SS-ZD were defined as ZD with septa < 20mm. Main outcomes were the rates of technical success, adverse events (AEs) – such as bleeding and perforation – clinical success and recurrence at 12 months. Clinical success was defined as a Dakkak – Bennett score < 1, while recurrence as the new onset of dysphagia after treatment, confirmed by a residual septum at barium esophagogram/esophagogastroduodenoscopy requiring retreatment. A sensitivity analysis was conducted using a propensity score matching [ 1 ] [ 2 ] [ 3 ] [ 4 ] [ 5 ] [ 6 ] [ 7 ]. Results A total of 94 patients (63.8% male; mean age 72.7 + 10.7 years) underwent septotomy with a men hospital stay of 0.3 days. Technical success was achieved in 100% of POES cases (n=55) and 97.4% of FES cases (n=38; p=0.8). The single technical failure in the FES group (2.6%; n=1) was attributed to intraprocedural bleeding. AEs occurred in 5.4% of POES cases (n=3: two bleedings and one perforation) and 5.1% of FES cases (n=2: one bleeding and one perforation), all successfully managed endoscopically (p=0.9). In the POES group, the three AEs comprised two delayed bleedings, occurring more than 24 hours after discharge, and one perforation, which was managed conservatively with nasogastric tube placement, broad-spectrum antibiotics, and fasting. In the FES group, AEs included one intraprocedural bleeding, necessitating placement of three TTSCs and resulting in technical failure, and one perforation, which was managed endoscopically. The propensity score matching-based sensitivity analysis confirmed no statistically significant differences in the main outcomes between the two groups (28 FES vs 28 POES; p=n.s.). Conclusions POES and FES are both effective and safe for managing SS-ZD, offering comparable technical and clinical outcomes with low adverse event and recurrence rates. These findings support the use of either approach, with the choice driven by institutional expertise. Randomized controlled trials are warranted to validate these results. Publication History Article published online: 27 March 2025 © 2025. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».