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

Steven Steinway; Linda Zhang; Julia Amundson; Jose Nieto; Pankaj Desai; Jeremie Jacques; Michael Bejjani; Mathieu Pioche; Nikhil Kumta; Oscar Hernandez-Mondragon; Michael Ujiki; Mouen Khashab

doi:10.1055/a-2067-9105

Endoscopy International Open, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Endoscopy 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

¹Johns Hopkins Medicine, Gastroenterology and Hepatology, Baltimore, Maryland, United States

,

Linda Zhang

¹Johns Hopkins Medicine, Gastroenterology and Hepatology, Baltimore, Maryland, United States

,

Julia Amundson

²University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States

,

Jose Nieto

³University of Central Florida, Department of Gastroenterology, Orlando, Florida, United States

,

Pankaj Desai

⁴Surat Institute of Digestive Sciences, GI Endoscopy, Surat, India

,

Jeremie Jacques

⁵CHU Dupytren Limoges, Service d’Hépato-gastro-entérologie, Limoges, France

,

Michael Bejjani

¹Johns Hopkins Medicine, Gastroenterology and Hepatology, Baltimore, Maryland, United States

,

Mathieu Pioche

⁶Hôpital Edouard Herriot, Endoscopy Unit, Digestive Disease Department, Lyon, France

,

Nikhil Kumta

⁷Icahn School of Medicine at Mount Sinai, Division of Gastroenterology, New York, New York, United States

,

Oscar Hernandez-Mondragon

⁸IMSS, Digestive Endoscopy, Mexico City, Mexico

,

Michael Ujiki

⁹NorthShore University Health Systems, NorthShore Center for Simulation and Innovation, Evanston, Illinois, United States

,

Mouen Khashab

¹Johns Hopkins Medicine, Gastroenterology and Hepatology, Baltimore, Maryland, United States

› Institutsangaben

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.

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Referenzen

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