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There are few data favoring the need for septotomy at the time of peroral endoscopic myotomy (POEM) or if POEM alone is sufficient. Our aim was to compare POEM outcomes with and without septotomy (POEM+S or POEM-S) in patients with symptomatic epiphrenic diverticula (ED) and an underlying motility disorder. This was an international, multicenter retrospective study involving 21 centers between January 2014 and January 2023. Patients with ED and an underlying motility disorder who underwent POEM were included. The primary outcome was clinical success (Eckardt score [ES] ≤3 or a 1-point drop in ES for patients with baseline ES <3) without the need for repeat surgical/endoscopic interventions during follow-up. A total of 85 patients (mean age, 64.29 ± 17.1 years; 32 [37.6%] female) with ED and underlying motility disorder underwent POEM+S (n = 47) or POEM–S (n = 38). Patients in the POEM+S group had a significantly higher mean pre-POEM ES (7.3 ± 2.1 vs 5.8 ± 2; P =.002). The most common indication for POEM was achalasia (51% in the POEM+S cohort and 51.8% in the POEM–S cohort; P =.7). A posterior approach was favored in the POEM+S group (76.6% vs 52.6%; P =.02). A similar rate of technical success was seen in both groups (97.9% vs 100%; P =.1). The rate of adverse events was similar between the 2 cohorts (4.2% vs 8.1%; P =.6). The median length of hospital stay after POEM–S was significantly longer compared with POEM+S (2 days [interquartile range (IQR), 1-4 days] vs 1 day [IQR, 1-2 days]; P =.005). Clinical success was equivalent between the 2 groups (83% vs 86.8%; P =.6) at a median follow-up duration of 8 months (IQR, 3-19 months). In patients with ED and an underlying motility disorder, both POEM+S and POEM–S are equally safe and effective, with similar procedure duration and a low recurrence rate at short-term follow-up. Future comparative prospective studies with long-term follow-up are required to validate these findings. [Display omitted] [ABSTRACT FROM AUTHOR]

Endoscopic submucosal dissection (ESD) is challenging for appendicular lesions. We report the outcomes of ESD in this context. We collected data of ESD procedures for appendiceal neoplasia in a multicenter prospective registry. Main study endpoints were R0, en-bloc, and curative resection rates and adverse event rate. One hundred twelve patients were included, 47 (42%) with previous appendectomy. Fifty-six (50%) were Toyonaga type 3 lesions (15 [13.4%] postappendectomy). En-bloc and R0 resection rates were 86.6% and 80.4%, respectively, with no significant difference associated with different grades of appendiceal invasion (P =.9 and P =.4, respectively) or previous appendectomy (P =.3 for both). The curative resection rate was 78.6%. Additional surgery was performed in 16 cases (14.3%), including 10 (62.5%) Toyonaga type 3 lesions (P =.04). This included the treatment of 5 cases (4.5%) of delayed perforation and 1 acute appendicitis. ESD for appendicular lesions is a potentially safer and effective alternative to surgery for a significant proportion of patients. [ABSTRACT FROM AUTHOR]