A266 OUTCOMES OF ENDOSCOPIC TREATMENT OF ZENKER’S DIVERTICULUM: EXPERIENCE IN A CANADIAN CENTRE
Bibliographic record
Abstract
A common cause of benign dysphagia in adults is Zenker’s diverticulum (ZD). Therapeutic options include rigid endoscopy or open surgical approach. These techniques may however be associated with complications such as recurrent nerve palsy and salivary fistula. Furthermore, patients with multiple comorbidities may not be fit for surgery. Treatment with flexible endoscopic diverticulotomy (FED) has been shown to be associated with lower complication rates and shorter hospital stays when compared with surgical approach. To describe the endoscopic technique and outcomes of FED for the treatment of ZD performed at our centre. All cases of ZD treated by FED performed from January 2012 to October 2018 were retrospectively reviewed. Patient demographics, comorbidities, pre-procedure symptoms, peri-procedural events and post-procedure outcomes were identified. Subjective improvement of symptoms after endoscopic treatment (dysphagia, regurgitation, choking) was counted as treatment success. Repeat FED procedures on the same patient were counted as distinct events. During the study period, 30 FEDs were performed in 18 patients, 83.3% of the population was male, median age at time of procedure was 71 years (range 49–87 years). All cases of FED were done under sedation by an anesthetist with orotracheal intubation. The procedures were done by a single endoscopist who performed the same endoscopic technique in all cases: CO2 insufflation, prior insertion of an oro-gastric tube and placement of a transparent hood at the scope tip. The cricopharyngeal myotomy was generally performed to 80–90% of the depth of the ZD pouch to maximize prevention of perforation. Nine patients underwent 1 session of FED, 6 patients underwent 2, and 3 patients underwent 3 FEDs. Ninety percent of patients had relief of symptoms after endoscopic treatment. One patient was referred for surgical repair due to recurrence of symptoms. Mild bleeding was reported in 15 cases (50%), this was self-limited in 3 (10%). Injection of adrenaline alone or electrocoagulation alone was required in 2 cases (6.7%), and hemoclip placement in 10 (33.3%). Prophylactic hemoclips were applied at the base of the defect in 4 cases (13.3%). Significant post-procedure pain was experienced in 1 patient (3%) but there was no perforation identified and resolved after 48 hours. With the exception of 1 case (patient was observed overnight for 24 hours), all FED cases were performed as day-case procedures with same day discharge after two hours of observation in recovery. No cases of perforation or other complications were reported. In our experience, FED is a safe and effective treatment modality for symptoms related to ZD. Mild intra-procedural bleeding was common but this was adequately managed by endotherapy. About half of patients may require repeated FED for full symptom resolution. None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".