PDF(Pubmed)
Abstract：
BACKGROUND: Bleeding from Zenker\'s diverticulum is extremely rare. At present, there are no guidelines for the management of bleeding Zenker\'s diverticulum because of its rarity. Per-oral endoscopic myotomy (Z-POEM) is a precision myotomy technique and minimally invasive procedure for the treatment of Zenker\'s diverticulum. We present a systematic review and a rare case of bleeding Zenker\'s diverticulum that was effectively treated using Z-POEM.
METHODS: A 72-year-old presented after 3 d of hematemesis. He had a 2-year history of progressive dysphagia and reported no antiplatelet, anticoagulant, or non-steroidal anti-inflammatory drug use. His vital signs were stable, and the hematocrit was 36%. Previous gastroscopy and barium swallow had revealed Zenker\'s diverticulum before the bleeding occurred. We performed gastroscopy and found a 5-mm ulcer with a minimal blood clot and spontaneously resolved bleeding. Z-POEM for definitive treatment was performed to reduce accumulation of food and promote ulcer healing. He had no complications and no bleeding; at the follow-up 6 mo later, the ulcer was healed.
CONCLUSIONS: Z-POEM can be definitive prevention for bleeding ulcer in Zenker\'s diverticulum that promotes ulcer healing, reducing the risk of recurrent bleeding. Z-POEM is also a definitive endoscopic surgery for treatment of Zenker\'s diverticulum.
METHODS: A 72-year-old presented after 3 d of hematemesis. He had a 2-year history of progressive dysphagia and reported no antiplatelet, anticoagulant, or non-steroidal anti-inflammatory drug use. His vital signs were stable, and the hematocrit was 36%. Previous gastroscopy and barium swallow had revealed Zenker\'s diverticulum before the bleeding occurred. We performed gastroscopy and found a 5-mm ulcer with a minimal blood clot and spontaneously resolved bleeding. Z-POEM for definitive treatment was performed to reduce accumulation of food and promote ulcer healing. He had no complications and no bleeding; at the follow-up 6 mo later, the ulcer was healed.
CONCLUSIONS: Z-POEM can be definitive prevention for bleeding ulcer in Zenker\'s diverticulum that promotes ulcer healing, reducing the risk of recurrent bleeding. Z-POEM is also a definitive endoscopic surgery for treatment of Zenker\'s diverticulum.
摘要：
背景：Zenker憩室出血极为罕见。目前,由于Zenker憩室的罕见性，因此没有治疗出血的指南。经口内镜下肌切开术（Z-POEM）是一种精确的肌切开术和微创手术，用于治疗Zenker憩室。我们提出了一个系统的评价和一个罕见的出血Zenker憩室，使用Z-POEM有效治疗。
方法：一名72岁的患者在3d吐血后出现。他有2年的进行性吞咽困难病史，报告没有抗血小板，抗凝剂,或非甾体抗炎药的使用。他的生命体征稳定,血细胞比容为36%。先前的胃镜检查和钡吞咽在出血发生前发现了Zenker憩室。我们进行了胃镜检查，发现5毫米溃疡，血凝块最少，出血自发解决。进行明确治疗的Z-POEM以减少食物的积累并促进溃疡愈合。他没有并发症，也没有出血；在6个月后的随访中，溃疡愈合。
结论：Z-POEM可以明确预防Zenker憩室出血性溃疡，促进溃疡愈合，降低复发性出血的风险。Z-POEM也是一种治疗Zenker憩室的权威内镜手术。
方法：一名72岁的患者在3d吐血后出现。他有2年的进行性吞咽困难病史，报告没有抗血小板，抗凝剂,或非甾体抗炎药的使用。他的生命体征稳定,血细胞比容为36%。先前的胃镜检查和钡吞咽在出血发生前发现了Zenker憩室。我们进行了胃镜检查，发现5毫米溃疡，血凝块最少，出血自发解决。进行明确治疗的Z-POEM以减少食物的积累并促进溃疡愈合。他没有并发症，也没有出血；在6个月后的随访中，溃疡愈合。
结论：Z-POEM可以明确预防Zenker憩室出血性溃疡，促进溃疡愈合，降低复发性出血的风险。Z-POEM也是一种治疗Zenker憩室的权威内镜手术。
