Zenker’s peroral endoscopic myotomy, or flexible or rigid septotomy for Zenker’s diverticulum: a multicenter retrospective comparison

Sarah S. Al Ghamdi; Jad Farha; Robert A. Moran; Mathieu Pioche; Frédéric Moll; Dennis J. Yang; Oscar V. Hernández Mondragón; Michael Ujiki; Harry Wong; Alina Tantau; Alireza Sedarat; M. Phillip Fejleh; Kenneth Chang; David P. Lee; Jose M. Nieto; Sherif Andrawes; Gregory G. Ginsberg; Monica Saumoy; Amol Bapaye; Parag Dashatwar; Mohamad Aghaie Meybodi; Ariana C. Lopez; Omid Sanaei; Muhammad N. Yousaf; Manol Jovani; Yervant Ichkhanian; Olaya I. Brewer Gutierrez; Vivek Kumbhari; Ashli K. O’Rourke; Eric J. Lentsch; B. Joseph Elmunzer; Mouen A. Khashab

doi:10.1055/a-1518-7223

Endoscopy, Inhaltsverzeichnis

Endoscopy 2022; 54(04): 345-351
DOI: 10.1055/a-1518-7223

Original article

Zenker’s peroral endoscopic myotomy, or flexible or rigid septotomy for Zenker’s diverticulum: a multicenter retrospective comparison

Sarah S. Al Ghamdi ‡^*

¹Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States

,

Jad Farha‡^*

¹Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States

,

Robert A. Moran

²Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, United States

,

Mathieu Pioche

³Gastroenterology, Edouard Herriot Hospital, Lyon, France

,

Frédéric Moll

³Gastroenterology, Edouard Herriot Hospital, Lyon, France

,

Dennis J. Yang

⁴Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, United States

,

Oscar V. Hernández Mondragón

⁵Division of Endoscopy, Specialties Hospital, National Medical Center Century XXI, Mexico City, Mexico

,

Michael Ujiki

⁶Division of Minimally Invasive Surgery, NorthShore’s Grainger Center for Simulation and Innovation, Evanston, Illinois, United States

,

Harry Wong

⁶Division of Minimally Invasive Surgery, NorthShore’s Grainger Center for Simulation and Innovation, Evanston, Illinois, United States

,

Alina Tantau

⁷Department of Gastroenterology, the 4th Medical Clinic, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania

,

Alireza Sedarat

⁸Ronald Reagan UCLA Medical Center, UCLA Medical Center, Los Angeles, California, United States

,

M. Phillip Fejleh

⁸Ronald Reagan UCLA Medical Center, UCLA Medical Center, Los Angeles, California, United States

,

Kenneth Chang

⁹H.H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Irvine, California, United States

,

David P. Lee

⁹H.H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Irvine, California, United States

,

Jose M. Nieto

¹⁰Borland Groover Clinic Advance Therapeutic Endoscopy Center and Baptist Medical Center, Jacksonville, Florida, United States

,

Sherif Andrawes

¹¹Division of Gastroenterology and Hepatology, Staten Island University Hospital – Northwell Health, Staten Island, New York, United States

,

Gregory G. Ginsberg

¹²Endoscopic Services, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, United States

,

Monica Saumoy

¹²Endoscopic Services, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, United States

,

Amol Bapaye

¹³Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India

,

Parag Dashatwar

¹³Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India

,

Mohamad Aghaie Meybodi

¹Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States

,

Ariana C. Lopez

¹Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States

,

Omid Sanaei

¹Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States

,

Muhammad N. Yousaf

¹⁴Medstar Union Memorial Hospital, Columbia, Maryland, United States

,

Manol Jovani

¹Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States

,

Yervant Ichkhanian

¹Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States

,

Olaya I. Brewer Gutierrez

¹Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States

,

Vivek Kumbhari

¹Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States

,

Ashli K. O’Rourke

¹⁵Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, United States

,

Eric J. Lentsch

¹⁵Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, United States

,

B. Joseph Elmunzer

²Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, United States

,

Mouen A. Khashab

¹Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States

› Institutsangaben

Abstract

Background Treatment of Zenker’s diverticulum has evolved from open surgery to endoscopic techniques, including flexible and rigid endoscopic septotomy, and more recently, peroral endoscopic myotomy (Z-POEM). This study compared the effectiveness of flexible and rigid endoscopic septotomy with that of Z-POEM.

Methods Consecutive patients who underwent endoscopic septotomy (flexible/rigid) or Z-POEM for Zenker’s diverticulum between 1/2016 and 9/2019 were included. Primary outcomes were clinical success (decrease in Dakkak and Bennett dysphagia score to ≤ 1), clinical failure, and clinical recurrence. Secondary outcomes included technical success and rate/severity of adverse events.

Results 245 patients (110 females, mean age 72.63 years, standard deviation [SD] 12.37 years) from 12 centers were included. Z-POEM was the most common management modality (n = 119), followed by flexible (n = 86) and rigid (n = 40) endoscopic septotomy. Clinical success was 92.7 % for Z-POEM, 89.2 % for rigid septotomy, and 86.7 % for flexible septotomy (P = 0.26). Symptoms recurred in 24 patients (15 Z-POEM during a mean follow-up of 282.04 [SD 300.48] days, 6 flexible, 3 rigid [P = 0.47]). Adverse events occurred in 30.0 % rigid septotomy patients, 16.8 % Z-POEM patients, and 2.3 % flexible septotomy patients (P < 0.05).

Conclusions There was no difference in outcomes between the three treatment approaches for symptomatic Zenker’s diverticulum. Rigid endoscopic septotomy was associated with the highest rate of complications, while flexible endoscopic septotomy appeared to be the safest. Recurrence following Z-POEM was similar to flexible and rigid endoscopic septotomy. Prospective studies with long-term follow-up are required.

Volltext

Referenzen

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