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CC BY-NC-ND 4.0 · Endosc Int Open 2023; 11(06): E607-E612
DOI: 10.1055/a-2067-9105
Original article

Long-term outcomes of Zenker’s peroral endoscopic myotomy (Z-POEM) for treatment of Zenker’s diverticulum

Steven Steinway
1   Johns Hopkins Medicine, Gastroenterology and Hepatology, Baltimore, Maryland, United States
,
Linda Zhang
1   Johns Hopkins Medicine, Gastroenterology and Hepatology, Baltimore, Maryland, United States
,
Julia Amundson
2   University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States
,
Jose Nieto
3   University of Central Florida, Department of Gastroenterology, Orlando, Florida, United States
,
Pankaj Desai
4   Surat Institute of Digestive Sciences, GI Endoscopy, Surat, India
,
Jeremie Jacques
5   CHU Dupytren Limoges, Service d’Hépato-gastro-entérologie, Limoges, France
,
Michael Bejjani
1   Johns Hopkins Medicine, Gastroenterology and Hepatology, Baltimore, Maryland, United States
,
Mathieu Pioche
6   Hôpital Edouard Herriot, Endoscopy Unit, Digestive Disease Department, Lyon, France
,
Nikhil Kumta
7   Icahn School of Medicine at Mount Sinai, Division of Gastroenterology, New York, New York, United States
,
Oscar Hernandez-Mondragon
8   IMSS, Digestive Endoscopy, Mexico City, Mexico
,
Michael Ujiki
9   NorthShore University Health Systems, NorthShore Center for Simulation and Innovation, Evanston, Illinois, United States
,
Mouen Khashab
1   Johns Hopkins Medicine, Gastroenterology and Hepatology, Baltimore, Maryland, United States
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Abstract

Background and study aims Z-POEM is now an established therapy for symptomatic Zenker’s diverticulum (ZD). Short-term follow-up of up to 1-year post Z-POEM suggests excellent efficacy and safety; however, long-term outcomes are not known. Thus, we sought to report on longer-term outcomes (≥ 2 years) following Z-POEM for treatment of ZD.

Patients and methods This was an International multicenter retrospective study at eight institutions across North America, Europe, and Asia over a 5-year period (from December 3, 2015 to March 13, 2020) of patients who underwent Z-POEM for management of ZD with a minimum 2-year follow-up. The primary outcome was clinical success, defined as improvement in dysphagia score to ≤ 1 without need for further procedures during the first 6 months. Secondary outcomes included rate of recurrence in patients initially meeting clinical success, rate of reintervention, and adverse events (AEs).

Results A total of 89 patients (male 57.3 %, mean age 71 ± 12 years) underwent Z-POEM for treatment of ZD (mean diverticulum size was 3.4 ± 1.3 cm). Technical success was achieved in 97.8 % of patients (n = 87) with a mean procedure time of 43.8 ± 19.2 minutes. The median post-procedure hospital stay was 1 day. There were eight AEs (9 %) (3 mild, 5 moderate). Overall, clinical success was achieved in 84 patients (94 %). Mean dysphagia, regurgitation, and respiratory scores all improved dramatically from 2.1 ± 0.8, 2.8 ± 1.3, and 1.8 ± 1.6 pre-procedure to 0.13 ± 0.5, 0.11 ± 0.5, and 0.05 ± 0.4, respectively, post-procedure at most recent follow-up (all P < 0.0001). Recurrence occurred in six patients (6.7 %) during a mean length of follow-up of 37 months (range 24 to 63 months).

Conclusions Z-POEM is a highly safe and effective treatment for Zenker’s diverticulum with durable treatment effect to at least 2 years.



Publication History

Received: 28 December 2022

Accepted after revision: 30 March 2023

Accepted Manuscript online:
03 April 2023

Article published online:
29 June 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

Comment to this article:

Endoscopy International Open – recently publishedEndoscopy 2023; 55(09): 886-886
DOI: 10.1055/a-2113-2502

 

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