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16 "Dysphagia"
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Original Articles
Flexible endoscopic treatment of Zenker’s diverticulum: a retrospective study in a single center from Turkey
Kerem Kenarli, Bülent Ödemiş
Received June 30, 2024  Accepted August 15, 2024  Published online December 12, 2024  
DOI: https://doi.org/10.5946/ce.2024.180    [Epub ahead of print]
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: We aimed to contribute to the literature by sharing the findings of patients treated by cricopharyngeal myotomy with a flexible endoscopic septal division.
Methods
This retrospective study included patients with Zenker’s diverticulum who underwent cricopharyngeal myotomy with a traditional flexible endoscopic septal division at our center. Clinical success was defined as a significant reduction in dysphagia score, and relapse was defined as an increase in dysphagia score occurring at any time over 1 month after the procedure.
Results
Fifteen patients with symptomatic Zenker’s diverticulum were treated with 16 cricopharyngeal myotomies. A dysphagia score of 100% indicated clinical success, but three (20%) of the patients experienced recurrence during follow-up.
Conclusions
While advances in interventional flexible endoscopy have opened doors for novel treatments, cricopharyngeal myotomy based on traditional flexible endoscopic septal division remains a reliable approach for treating Zenker’s diverticulum.
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Experience with Peroral Endoscopic Myotomy for Achalasia and Spastic Esophageal Motility Disorders at a Tertiary U.S. Center
Maen Masadeh, Peter Nau, Subhash Chandra, Jagpal Klair, John Keech, Kalpaj Parekh, Rami El Abiad, Henning Gerke
Clin Endosc 2020;53(3):321-327.   Published online November 20, 2019
DOI: https://doi.org/10.5946/ce.2019.110
AbstractAbstract PDFPubReaderePub
Background
/Aims: Peroral endoscopic myotomy (POEM) is a novel procedure for the treatment of achalasia and spastic esophageal disorders. Experience with POEM is limited, but its reported outcomes are excellent. It is deemed safe even for patients with prior interventions.
Methods
This retrospective review included patients who underwent POEM at a tertiary US center. POEM was performed in a multidisciplinary approach by advanced endoscopists and foregut surgeons. Clinical success was defined as a post-POEM Eckardt score ≤3.
Results
A total of 125 patients were included. Median follow-up period was 18 months (interquartile range, 10–22 months). Clinical success was achieved in 92% of patients and persisted at 12 months in 88% of patients. Mucosal barrier failure (MBF) occurred in 7 patients, 2 of whom required surgical intervention. MBF was more common in patients with prior laparoscopic Heller myotomy (19% vs. 3%, p=0.015). MBF requiring surgical intervention occurred early in the learning curve.
Conclusions
POEM is safe and effective in the treatment of achalasia and spastic esophageal disorders even after failed prior interventions.

Citations

Citations to this article as recorded by  
  • Comparing clinical outcomes of peroral endoscopic myotomy for achalasia between Eastern and Western countries: a systematic review and meta-analysis
    Han Zhang, Xinxin Pu, Shu Huang, Huifang Xia, Kang Zou, Xinyi Zeng, Jiao Jiang, Wensen Ren, Yan Peng, Muhan Lü, Xiaowei Tang
    Diseases of the Esophagus.2024;[Epub]     CrossRef
  • Surgical and per-oral endoscopic myotomy (POEM) for the treatment of primary esophageal motility disorders: A systematic analysis of current trends in Germany between 2011 and 2019
    Jennis Kandler, Tobias Essing, David Schöler, Georg Flügen, Wolfram T. Knoefel, Christoph Roderburg, Tom Luedde, Sven H. Loosen, Dong Keon Yon
    PLOS ONE.2024; 19(1): e0297265.     CrossRef
  • Learning curve for esophageal peroral endoscopic myotomy: a systematic review and meta-analysis
    Srinivas R. Puli, Mihir S. Wagh, David Forcione, Harishankar Gopakumar
    Endoscopy.2023; 55(04): 355.     CrossRef
  • Management of the patient with esophagogastric junction outflow obstruction
    Dariush Shahsavari, Zubair Malik, Henry P. Parkman
    Current Opinion in Gastroenterology.2021; 37(4): 397.     CrossRef
  • Long-term Outcomes of Per-oral Endoscopic Myotomy in Spastic Esophageal Motility Disorders
    Zaheer Nabi, Radhika Chavan, Mohan Ramchandani, Jahangeer Basha, Nitin Jagtap, Arun Karyampudi, Santosh Darisetty, Manu Tandan, Rajesh Goud, Guduru Venkat Rao, Duvvur Nageshwar Reddy
    Journal of Clinical Gastroenterology.2021; 55(7): 594.     CrossRef
  • Outcomes of peroral endoscopic myotomy in patients with achalasia and prior bariatric surgery: A multicenter experience
    S Bomman, J S Klair, M Ashat, R El Abiad, H Gerke, J Keech, K Parekh, P Nau, Y Hanada, L M Wong Kee Song, R Kozarek, S Irani, D Low, A Ross, R Krishnamoorthi
    Diseases of the Esophagus.2021;[Epub]     CrossRef
  • Spastic Motility Disorders: Diagnosis and Management in the Era of the Chicago Classification
    Mario Costantini, Renato Salvador, Andrea Costantini
    Foregut: The Journal of the American Foregut Society.2021; 1(3): 254.     CrossRef
  • Non-achalasia esophageal motility disorders: Role of per-oral endoscopic myotomy
    Zaheer Nabi, Duvuur Nageshwar Reddy
    International Journal of Gastrointestinal Intervention.2020; 9(2): 67.     CrossRef
  • Peroral Endoscopic Myotomy, a Well-Established, Efficacious, and Safe Treatment Option for Achalasia: Is the History of Previous Treatment a Hurdle or Not?
    Young Hoon Youn
    Clinical Endoscopy.2020; 53(3): 247.     CrossRef
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Case Report
Removal of Esophageal Variceal Bands to Salvage Complete Esophageal Obstruction
Ala’ A Abdel Jalil, Ghassan Hammoud, Jamal A Ibdah, Sami Samiullah
Clin Endosc 2018;51(5):491-494.   Published online August 21, 2018
DOI: https://doi.org/10.5946/ce.2018.011
AbstractAbstract PDFPubReaderePub
Esophageal varices develop in almost half of the patients with cirrhosis, and variceal hemorrhage constitutes an ominous sign with an increased risk of mortality. Variceal banding is considered an effective and mostly safe measure for primary and secondary prophylaxis. Although adverse events related to banding including dysphagia, stricture formation, bleeding, and ligation-induced ulcers have been described, complete esophageal obstruction is rare, with only 10 reported cases in the literature. Among those cases, 6 were managed conservatively; 1 patient had esophageal intraluminal dissection from an attempt to remove the bands using biopsy forceps but ultimately recovered with conservative management. Three patients developed strictures following removal of the bands, requiring repeated sessions of dilation therapy. We report on a patient who developed absolute dysphagia and complete esophageal obstruction after variceal banding. We successfully used the endoloop cutter hook to release the bands intact and restore luminal integrity.

Citations

Citations to this article as recorded by  
  • Esophageal necrosis and obstruction after esophageal variceal banding
    Simran Gupta, Emily Zhou, Jason Ferreira, Arkadiy Finn
    Journal of Brown Hospital Medicine.2022;[Epub]     CrossRef
  • 6,782 View
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  • 1 Crossref
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Analysis of the Clinicopathologic Features of Eosinophilic Esophagitis: Comparative Study with Nonobstructive Dysphagia
Kwang Hyun Kim, M.D., Il Hyung Chung, M.D., Jie-Hyun Kim, M.D., Young Hoon Youn, M.D., Sun Och Yoon, M.D.*, Hyojin Park, M.D. and Sang In Lee, M.D.
Korean J Gastrointest Endosc 2011;42(3):143-151.   Published online March 28, 2011
AbstractAbstract PDF
Background/Aims: Eosinophilic esophagitis (EoE) has emerged as one of the most common causes of dysphagia and esophageal food impactions. However, it is doubtful that gastroenterologists and pathologists make the correct diagnosis of EoE because of the insufficient recognition of EoE based on the endoscopic and pathological findings. This study was performed to investigate the symptoms and the endoscopic and pathologic findings of EoE as compared with those of nonobstructive dysphagia (NOD).

Methods: We retrospectively reviewed the medical records and the endoscopic and pathologic findings from 12 patients who were diagnosed with EoE based on an eosinophil count of ≥20 per high-power field (HPF) and 13 patients diagnosed with NOD, and these patients were treated at our hospital from June 2006 till October 2010.

Results: The endoscopic findings of EoE included rings (41.7%), furrows (75.0%), exudates (33.3%), mucosal friability (8.3%) and multi-findings (6.7%). Furrows and multi-findings were identified more frequently in EoE as comparison to that in NOD. The pathologic findings revealed that the maximal eosinophil counts/HPF were 87.2 (range 20∼232) and 2.2 (0∼11) in EoE and NOD, respectively. Moreover, eosinophil microabscess (58.3%), degranulation (100%) and spongiosis (91.7%) were more significantly observed in EoE compared with that in NOD.

Conclusions: EoE had specific endoscopic and clinicopathologic features that distinguish it from NOD. For patients with dysphagia, the endoscopic and pathologic findings of EoE should be kept in mind. (Korean J Gastrointest Endosc 2011;42:143-151)

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Eosinophilic Esophagitis
Yun Ju Jo, M.D.
Korean J Gastrointest Endosc 2009;39(6):329-337.   Published online December 30, 2009
AbstractAbstract PDF
Eosinophilic esophagitis, as a new emerging disease during the last decade, is a clinicopathologic disorder of the esophagus, and it is characterized by dense esophageal eosinophilic infiltrations and typical esophageal symptoms. These patients usually present with dysphagia, food impaction or refractory reflux symptoms, and biopsy of the esophagus shows more than 15 eosinophils per high-power field. The typical findings on endoscopy are linear furrows, ringed esophagus, mucosal nodularities, whitish plaques and/or stricture. It is essential to exclude the known causes of tissue eosinophilia such as gastroesophageal reflux disease, eosinophilic gastroenteritis, infections, drug, hypersensitivity, Crohn's disease or malignancy. The majority of these patients have an atopy or allergic disorders, so other causes of eosinphilia should be evaluated. The therapeutic options include acid suppression, steroids, dietary modification, endoscopic dilatation, etc. Eosinophilic esopahgitis has recently been reported in Korea. Future schematic studies about this new disease are needed. (Korean J Gastrointest Endosc 2009;39:329-337)
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A Case of Esophageal Peptic Stricture Concomitant with Vascular Ring in Mid-Esophagus
Ki Byung Lee, M.D., Hyun Chul Lim, M.D., Hye Yeon Park, M.D., Jae Joon Jung, M.D.* and Hyo Jin Park, M.D.
Korean J Gastrointest Endosc 2009;39(4):248-251.   Published online October 30, 2009
AbstractAbstract PDF
Esophageal strictures may result from common conditions such as gastroesophageal reflux disease. Dysphagia is by far the most common presenting complaint in patients with esophageal peptic stricture. Symptomatic peptic strictures are treated by dilatation via ballooning or bougienation. Vascular ring is a term given to a combination of vascular and often ligamentous structures that encircle the trachea and esophagus. Symptomatic vascular ring, also known as dysphagia lusoria, is generally treated by conservative management. However, surgery should be considered when symptoms persist regardless of the treatment. We experienced a case involving a 41-year-old man with dysphagia diagnosed with peptic stricture on upper endoscopy and concomitant vascular ring on chest CT, which proved asymptomatic. (Korean J Gastrointest Endosc 2009;39:248-251)
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A Case of an Esophageal Bronchogenic Cyst Presenting with Dysphagia
Hee Jung Lee, M.D., Hee Seok Moon, M.D., Jae Kyu Sung, M.D., Hyun Yong Jeong, M.D., Hyun Jung Lee, M.D.* and Dae Young Kang, M.D.*
Korean J Gastrointest Endosc 2009;39(3):154-157.   Published online September 30, 2009
AbstractAbstract PDF
Bronchogenic cysts are rare congenital anomalies that are formed due to abnormal budding of the endodermal foregut during embryogenesis. These cysts are found at various sites because the location of the cyst depends on the embryological state of the abnormal budding. Submucosal tumors (SMTs) of the esophagus that originate from the submucosa or the intramural layer account for less than 1% of all esophageal neoplasms, and bronchial cysts of the esophagus usually present as a type of SMT or as external compression. We report here on an interesting case of bronchogenic cyst presenting with dysphagia in an adult. (Korean J Gastrointest Endosc 2009;39:154-157)
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A Case of Double Primary Cancer in the Esophagus
Jeong Yo Min, M.D., Hyun Jeong Lee, M.D., Hye Suk Son, M.D., Jin Su Kim, M.D., Hyung Keun Kim, M.D., Young Seok Cho, M.D. and Hiun Suk Chae, M.D.
Korean J Gastrointest Endosc 2009;38(1):24-27.   Published online January 30, 2009
AbstractAbstract PDF
Double primary cancer is usually accompanied by gastrointestinal cancer. The incidence of histologically different cancers in the same organ is less than that of double cancers arising from different organs. The cancers accompanied by esophageal squamous cell carcinoma are laryngopharyngeal cancer, gastric adenocarcinoma and primary hepatocarcinoma. Esophageal cancer is supposed to be frequently accompanied by squamous cell carcinoma of the head and neck or the upper respiratory tract because of such common carcinogens as smoking and alcohol ingestion. On the other hand, it is vary rare that a synchronous double primary cancer is diagnosed at the esophagus. We present here a case of double esophageal cancer in a 77 year-old patient who visited our hospital because of progressive dysphagia that she'd experienced for 3 weeks. (Korean J Gastrointest Endosc 2009;38:24-27)
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A Case of Dysphagia Lusoria Caused by an Aberrant Right Subclavian Artery in an Adolescent
Eun Jung Shin, M.D., Hyung Keun Kim, M.D., Jin Soo Kim, M.D., Young Seok Cho, M.D., Woo Hyung Choi, M.D., Yong Wan Park, M.D., Hye Suk Son, M.D., Hiun Suk Chae, M.D. and Kyu Yong Choi, M.D.
Korean J Gastrointest Endosc 2008;36(4):213-218.   Published online April 30, 2008
AbstractAbstract PDF
Dysphagia lusoria is used to describe the symptomatic compression of the esophagus from an anomalous vessel of the aortic arch. A right aortic arch with an aberrant left subclavian artery is the most common type of aortic arch abnormalities, followed by double aortic arch, and then an aberrant right subclavian artery. These anomalous vessels may cause dysphagia from the compression of the esophagus in adults, but they usually do not produce symptoms and they are usually found incidentally. Several cases of adult dysphagia lusoria have been reported in Korea, but there has been no reported case in an adolescent. We experienced a case of a 17-year-old female who suffered from dysphagia. We evaluated the possible causes of her dysphagia by performing esophagogastroduodenoscopy, esophagoraphy, esophageal manometry and chest computed tomography. We finally diagnosed this case as dysphagia lusoria caused by an aberrant right subclavian artery. (Korean J Gastrointest Endosc 2008;36:213-218)
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Three Cases of Eosinophilic Esophagitis with Dysphagia as a Chief Complaint
Byungjun Lee, M.D., Hyojin Park, M.D., Hongsun Yoon, M.D., Hyun Ki Kim, M.D.* and Hee Sun Kim, M.D.
Korean J Gastrointest Endosc 2008;36(3):145-149.   Published online March 30, 2008
AbstractAbstract PDF
The incidence of adult eosinophillic esophagitis has been on the increase greatly in recent years, but the disease has been rarely reported in Korea. Eosinophilic esophagitis is a chronic inflammatory disease causing dysphagia and food impaction. A round ring, longitudinal furrows and mucosal friability are the major findings seen by endoscopy. Eosionophilc esophagitis is confirmed by pathology when more than 20 eosinophils are found on microscopy with use of a high power field. We experienced three cases of eosinophilic esophagitis with complaints of dysphagia. (Korean J Gastrointest Endosc 2008;36:145-149)
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A Case of Esophageal Intramural Pseudodiverticulosis
Ji Hyun Kim, M.D., Se Yune Kim, M.D., Jong Hwan Choi, M.D., Jong Jin Hyun, M.D., Byung Gyu Kim, M.D., Ji Hoon Kim, M.D., Yeon Seok Seo, M.D., Jin Yong Kim, M.D., Jong-Jae Park, M.D., Jae Seon Kim, M.D. and Young-Tae Bak, M.D.
Korean J Gastrointest Endosc 2005;31(5):311-314.   Published online November 30, 2005
AbstractAbstract PDF
Esophageal intramural pseudodiverticulosis is a rare condition with an unknown etiology, and it is characterized by the typical morpholgic findings of multiple tiny pseudodiverticula in a portion of, or in the entire length of the esophagus. It has two peaks in incidence, the teen years and between the 5th and 7th decade. Most patients present with dysphagia, and radiological narrowing of the esophagus is commonly seen. The clinical course of this condition is benign and dilatation of any strictures, if present, results in an excellent clinical response. We report here on a case of esophageal intramural pseudodiverticulosis in a 76-year-old man who had a 6-year history of dysphagia, and we also include a review of the literature. (Korean J Gastrointest Endosc 2005;31:311⁣314)
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A Case of Esophageal Obstruction after Cyanoacrylate Injection Sclerotherapy
Won Joong Jeon, M.D., Jeong Chul Seo, M.D., Seong Woo Lim, M.D., Ki Man Lee, M.D., Hee Bok Chae, M.D., Seon Mee Park, M.D., Il Hun Bae, M.D.*, Seong Jin Kim, M.D.* and Sei Jin Youn, M.D.
Korean J Gastrointest Endosc 2005;31(4):243-247.   Published online October 30, 2005
AbstractAbstract PDF
Cyanoacrylate is well recognized for its effect in the treatment of the gastric variceal bleeding rather than the esopahgeal variceal bleeding. We used endoscopic injection sclerotherapy (EIS) with cyanoacrylate for the control of esophageal variceal bleeding in which endoscopic variceal ligation (EVL) was difficult due to severe post-EVL scar changes of the esophageal mucosa. The hemostasis by EIS with cyanoacrylate was successfully achieved despite the massive bleeding. However, esophageal obstruction occurred after the EIS treatment. Later, the obstruction resolved spontaneously as the polymer was expelled into the esophageal lumen. We report this case with a brief review of the literatures. (Korean J Gastrointest Endosc 2005;31:243⁣247)
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A Case of Small Cell Carcinoma in the Stomach
Sang Seok Bae, M.D., Jae Hong Choi, M.D., Hee Bock Chae, M.D., Seon Mee Park, M.D.,
Korean J Gastrointest Endosc 2004;28(6):307-311.   Published online June 30, 2004
AbstractAbstract PDF
Small cell carcinoma (SmCC) of stomach is a very rare and aggressive malignancy with extremely poor prognosis. Most patients with gastric SmCC die within 1 year of diagnosis. A standard treatment for gastric SmCC has not been established, but surgical excision and/or combination chemotherapy should be considered to promote long term survival. We report a case of small cell carcinoma of stomach in a 66-year-old woman with dysphagia. A gastroscopic examination revealed a polypoid mass with ulceration on the lesser curvature of the gastric body extending to the gastro-esophageal junction. An endoscopic biopsy showed a solid proliferation of small, monotonous tumor cells with hyperchromatic nuclei and scanty cytoplasm. Immunohistochemically, the neoplastic cells were positive for chromogranin, synaptophysin and NSE, and negative for CD45. No tumor was detected on examination of the chest. Therefore, primary SmCC was diagnosed preoperatively. (Korean J Gastrointest Endosc 2004;28:307⁣311)
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A Case of Plummer-Vinson Syndrome
Je-Wook Chae, M.D., Hyun Wook Jung, M.D., Jun Haeng Lee, M.D., Poong-Lyul Rhee,
Korean J Gastrointest Endosc 2004;28(2):67-70.   Published online March 1, 2004
AbstractAbstract PDF
The combination of symptomatic hypopharyngeal webs and iron-deficiency anemia in middle-aged women constitutes Plummer-Vinson syndrome. It is uncommon but important syndrome because of inceased risk of squamous cell carcinoma of the pharynx and esophagus. The cause of this syndrome is still not clear. A small sized web is treated by correction of anemia, but a large sized one with dysphagia is treated by breakage of web. Recently, we experienced a 41-year-old woman with Plummer-Vinson syndrome. She complained of dysphagia for 10 years. Esophagogram and endoscopic examination showed a hypopharyngeal web and peripheral blood profile was compatible with iron-deficiency anemia. Her symptom improved after endoscopic balloon dilatation of the upper esophageal web. (Korean J Gastrointest Endosc 2004; 28:67⁣70)
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구연 / 포스터 : 식도의 종양성 병변과 유사한 식도결핵
Korean J Gastrointest Endosc 2001;22(5):340-340.   Published online November 30, 2000
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성인에서의 혈관윤에 의한 연하곤란 3 예 ( Three Cases of Dysphagia Due to Vascular Ring in Adults )
Korean J Gastrointest Endosc 2000;21(3):735-740.   Published online November 30, 1999
AbstractAbstract PDF
Vascular rings resulting from abnormalities of the aortic arch can cause symptoms of esophageal or tracheal compression early in life. Right aortic arch with aberrant left subclavian artery is the most common type of aortic arch abnormalities, followed by double aortic arch, and then left arch with aberrant right subclavian artery. These anomalous vessels usually do not produce symptoms, but occasionally symptomatic patients require surgical intervention. Development of symptoms later in life is due to atherosclerotic enlargement of the arch (Kommerell's diverticulum). We experienced three adults who had anomalous vessels with dysphagia. Diagnosis was made by esophagography and chest CT. Of these three patients, one patient had Kommerell's diverticulum and underwent surgical repair to prevent rupture of an enlarged diverticulum as well as to relieve dysphagia. We consider that diagnosis of dysphagia caused by anomalous vessel is made by noninvasive chest CT and that the patients who have enlarged diverticulum should undergo surgical repair even with mild symptoms to prevent vascular rupture.
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