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The main purpose of this trial is to evaluate two devices used in the treatment of Zenker Diverticulum using flexible endoscopy (LigaSure and SB-knife). Analyze the technical success, clinical success, relapses, complications, and the mean procedure time with each device prospectively in order to transfer objective and uniform results to routine clinical practice.
Patients who meet the inclusion criteria will be randomized on the day of the procedure using a computer system that generates a table of random numbers, to perform endoscopic diverticulotomy using a LigaSure device (LS 1500, Covidien; Medtronic, Minneapolis, MN, USA) or with Stag Beetle (SB) knife standard (Sumitomo Bakelite Co. Tokyo, Japan).
Prophylactic intravenous antibiotic therapy is administered prior to the procedure and will be performed under deep sedation with control by an endoscopist or anesthesiologist in the cases indicated.
Gastroscopy will be performed to identify Zenker's diverticulum, and isolate the septum under endoscopic control using a diverticuloscope or flexible overtube (ZD overtube, ZDO 22/30 Cook Medical), after placing a guide (0.035 ", 450 cm Jagwire, Boston Scientific, Natick MA, USA) in the esophageal lumen. The overtube has two leaflets at one of its ends, a longer one that is placed in the esophageal lumen and the short leaflet is placed in the diverticulum. In those cases in which it is not possible to place the diverticuloscope, the septum will be isolated with the help of a cap on the end of the endoscope. In these cases, the device used will always be the SB-Knife since it is not possible to use the LigaSure and they will be excluded from the study analysis.
The time of the procedure will be counted from when the overtube is placed until it is removed after diverticulotomy.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Vessel sealing device | Active Comparator | Endoscopic diverticulectomy is performed with the LigaSure (TM) device |
|
| Dissecting Knife device | Active Comparator | Endoscopic diverticulectomy is performed with the SB-Knife(TM) device |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| septotomy | Device | endoscopic diverticulotomy |
|
| Measure | Description | Time Frame |
|---|---|---|
| Evaluate the technical success of endoscopic diverticulotomy with SB-Knife and LigaSure | Technical success: achieving septotomy of the mucosa and transverse muscle fibers of the diverticulum septum. | At the moment of the procedure |
| Evaluate clinical success of endoscopic diverticulotomy with SB-Knife and LigaSure | Clinical success: disappearance of symptoms or their improvement one month after treatment, evaluated using the Eating-Assessment Tool-10 (>=3 pathological) and Dakkak and Bennett scales (0: asymthomatic; 4 aphagia) | One month after the procedure |
| Measure | Description | Time Frame |
|---|---|---|
| Analyze the mean procedure time with each of the two endoscopic techniques | The procedure time will be counted from the overtube is placed until it is removed after diverticulectomy | At the end of the recruitment |
| Analyze immediate and delayed complications with SB-Knife and LigaSure |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Mª Henar Núñez-Rodriguez, MD PhD | Gastroenterology Department, Hospital Rio Hortega | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Mª Henar Núñez Rodriguez, | Valladolid | Valladolid | 47001 | Spain |
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| ID | Term |
|---|---|
| D016672 | Zenker Diverticulum |
| ID | Term |
|---|---|
| D004936 | Diverticulum, Esophageal |
| D004240 | Diverticulum |
| D000076385 | Diverticular Diseases |
| D005759 | Gastroenteritis |
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Complications during the procedure and post-procedure the first 14 days after the procedure):
Late complications (from the 15th day and during the first month):
|
| one month after the procedure |
| Determine the recurrence rates and the mean time to recurrence for each of the techniques | Recurrence: reappearance of symptoms (dysphagia, cough ...) after their disappearance or worsening, reflected in an increase in the scores of the Dakkak and Bennett scales (score ≥1 or increase of 1 point) and EAT -10 (EAT-10 score ≥3 or 3-point increase from previous score). | at least three months after the procedure |
| D005767 |
| Gastrointestinal Diseases |
| D004066 | Digestive System Diseases |
| D020763 | Pathological Conditions, Anatomical |
| D013568 | Pathological Conditions, Signs and Symptoms |