Third-Space Approach Vs Flexible Endoscopic Septotomy For The Treatment Of Short-Septum Zenker’s Diverticulum

Aims Flexible endoscopic septotomy (FES) has been reported as a safe and effective treatment for Zenker’s diverticulum (ZD). However, patients with short septum (ss;≤20mm) ZD still represent a difficult-to-treat subgroup of patients because of the anatomical limitation leading to reduced operating space for both rigid and flexible endoscopic treatments. Recently, third space tunneling approaches, namely Z-POEM and POES,have been developed to allow a safer,more complete myotomy; however, comparison data the standard flexible septotomy are still lacking. This is a retrospective analysis, comparing efficacy and safety between septotomy performed by a luminal or a third space approach (POES) for treating ssZD.

Methods All patients with ZD who were referred for flexible endoscopic septotomy were included in a prospectively maintained database. Exclusion criteria consisted of septum>20mm and follow up time shorter than 12months. Persistent complete or near-complete resolution of dysphagia (D&B:0or1) was defined as clinical success. Adverse events and procedure time were also recorded. Efficacy and safety outcomes were assessed at two different follow-up time points (12-months and 24-months).

Results From February 2011 to December 2019, 142 patients have been treated for ssZD by FES(n = 107)and POES(n = 35). The two groups did not differ in terms of demographics (FESgroup:68.9±12.0,M/F:66/41, ASA:1.8±0.6.POES group:68.9±14.1,M/F19/16, ASA2.1±0.6) and baseline clinical features (FESgroup:mean septum size:17.5±11.1; mean dysphagia score:2.6±0.6.POES group:septum size:1.4±6.8; mean dysphagia score 2.5±0.5). Mean procedural time was19.7±7.3 and 13.6±6.3, respectively. Two perforations and one case of post procedural fever occurred in the FES Group. One case of intra-procedural bleeding occurred in the POES Group.

The 86.9 % (93/107) and 94.3 % (33/35) of patients were asymptomatic at 12 months follow-up time point after FES and POES respectively (p:0.23). A persistent clinical success was reported for the 80.3 % (86/107) and 91.5 % (32/35) of patients at the 24 months follow-up time point after FES and POES respectively (p:0.13). Patients with symptoms recurrence were all treated by repeating a flexible endoscopic approach.

Conclusions A novel third-space approach appears to be at least comparable to standard flexible endoscopic septotomy in terms of mid-term efficacy and safety for treating short-septum ZD.

Citation: Maselli R, Spadaccini M, Fugazza A et al. OP224 THIRD-SPACE APPROACH VS FLEXIBLE ENDOSCOPIC SEPTOTOMY FOR THE TREATMENT OF SHORT-SEPTUM ZENKER’S DIVERTICULUM. Endoscopy 2021; 53: S92.

Publication History

Article published online:
19 March 2021