Su1139 PRIMARY STUDY ON SUBMUCOSAL TUNNELING ENDOSCOPIC SEPTUM DIVISION FOR ESOPHAGEAL DIVERTICULUM

Abstract

Submucosal tunneling endoscopic septum division (STESD) is a minimal invasive surgical therapy for esophageal diverticulum. This study is to evaluate the efficacy and safety of this operation. Patients with typical symptoms (dysphagia, regurgitation, foreign body sensation, etc.) who received STESD during April 2016 to June 2017 were included in this study. Patients with atypical symptoms or those with other esophageal motility disorders were excluded. STESD was performed by 4 steps: 1) mucosal incision; 2) submucosal tunneling; 3) septum division; and 4) mucosal closure. SF-36 health survey was used for the assessment of quality of life. A total of 8 patients were included in this study, the mean age was 59.9 years old (range, 39-80). There were 3 male patients and 5 females. Among them, 3 (3/8, 37.5%) were diagnosed with Zenker’s diverticulum, 4 (4/8, 50.0%) were diagnosed with epiphrenic diverticulum, 1 (1/8, 12.5%) was diagnosed with mid-esophageal diverticulum. The mean procedure time was 47.0 mins (range, 22-106mins, SD, 27.6mins). The mean of hospital stay after surgery was 4.3 days (range, 3-9days, SD, 2.0days). Mucosal injury was found in 2 patients during the procedure, and was closed by hemostatic clips, no major adverse event was found during hospital stay or after discharge. The depth of diverticulum (vertical distance from the septum to the bottom) was 23.13±8.43mm before and 19.25±8.88mm after STESD (mean±SD, p=0.281, two-tail-t-test). 2 patients (2/8, 25.0%) were completely symptom-free, 5 (5/8, 62.5%) reported relieved symptoms after the procedure, and only one (1/8, 12.5%) complained no significant change after the surgery (Table 1). One patient was lost to follow up the SF-36 scale. In patients who accomplished the follow-up, the total score of SF-36 was 112.1±27.1 before and 134.9±10.0 after the procedure (mean±SD, p=0.034, t-test). Among 8 sub-scales analysis of SF-36, GH (general health) and VT (vitality) analysis after surgery showed significant improvement with those before surgery (p=0.018 in GH, p=0.013 in VT, t-test). Various degrees of weight gain after STESD were observed, except one patient who lost weight through exercising. Submucosal tunneling endoscopic septum division can efficiently improve patients’ quality of life, especially in general health and vitality. Furthermore, based on our pilot study to date, this procedure is safe, although prospective studies in large scales are still needed.Tabled 1Table 1. Main symptoms before and after STESDCaseSiteBeforeAfterMain SymptomSeverityFrequencyMain SymptomSeverityFrequency1Zenker’sChest tightnessModerateEverydayChest tightnessMildEverydayForeign body sensationModerateEveryday---2EpiphrenicRegurgitation of foodSevere1∼2/monthAcid refluxModerate3∼4/half a year3EpiphrenicDysphagiaSevereEverydayDysphagiaModerateEverydayRegugitation of foodMild1∼2/weekAcid refluxModerate1∼2/week4EpiphrenicDysphagiaSevereEveryday---5Zenker’sDysphagiaSevereEveryday------Foreign body sensation*Mild2∼3/week6EpiphrenicDysphagiaModerateEveryday------Gurgling after meal*Mild3∼4/week7Zenker’sDysphagiaSevereEveryday---8**Mid-esophagealDysphagiaSevereEverydayDysphagiaMild3∼4/weekAcid refluxModerateEveryday---*Emerging symptoms **Lost to follow-up at 4-month after STESD Open table in a new tab