1. Zenker's peroral endoscopic myotomy for management of large Zenker's diverticulum.
- Author
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Zhang, Linda Y., Hernández Mondragón, Oscar, Pioche, Mathieu, Steinway, Steven N., Nieto, Jose, Ujiki, Michael B., VanDruff, Vanessa N., Kim, Raymond E., Canakis, Andrew, Tantau, Marcel, Tantau, Alina, Pop, Anamaria, Jacques, Jérémie, Lajin, Michael, Desai, Pankaj, Shrigiriwar, Apurva, Bejjani, Michael, Kumta, Nikhil A., and Khashab, Mouen A.
- Subjects
DIVERTICULUM ,ENDOSCOPIC surgery ,MYOTOMY - Abstract
Background Zenker's diverticulum peroral endoscopic myotomy (zPOEM) is a minimally invasive treatment strategy for Zenker's diverticulum, with excellent results for management of small-to-moderate Zenker's diverticulum. We evaluated its use in the management of large Zenker's diverticulum. Methods This was a retrospective multicenter cohort study across 11 international centers including adult patients with large Zenker's diverticulum ≥ 40 mm treated by zPOEM between March 2017 and March 2022. The primary outcome was clinical success (dysphagia score ≤ 1 without need for further intervention). Secondary outcomes included technical success (complete myotomy as intended), adverse events (AEs), and rate of recurrence. Results 83 patients (male 62.7 %, mean age 72.6 [SD 11.5] years) underwent zPOEM for treatment of large Zenker's diverticulum (median size 50 mm, interquartile range [IQR] 41–55 mm, range 40–80 mm). The zPOEM procedure was technically successful in 82 patients (98.8 %), with a mean procedure time of 48.7 (SD 23.2) minutes. Clinical success was achieved in 71 patients (85.5 %). Median (IQR) symptom scores improved significantly from baseline for dysphagia (2 23 vs. 0 [0–2]; P < 0.001), regurgitation (3 234 vs. 0 [0–0]; P < 0.001), and respiratory symptoms (2 [0–3] vs. 0 [0–0]; P < 0.001). Among patients achieving clinical success, only one recurrence (1.4 %) was recorded during a median follow-up of 12.2 months (IQR 3–28). Post-procedure AEs, all mild to moderate, occurred in four patients (4.8 %). Conclusion: This study demonstrated safe and effective use of zPOEM in the management of large Zenker's diverticulum. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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