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Endoscopy 2024; 56(01): 41-46
DOI: 10.1055/a-2182-5853
Innovations and brief communications

Direct diverticular peroral endoscopic myotomy for the treatment of thoracic esophageal diverticula: technique and outcomes

Julia L. Gauci 
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
,
Sunil Gupta 
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
2   Westmead Clinical School of Medicine, The University of Sydney, Sydney, Australia
,
Muhammad Abu Arisha
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
,
Andrew Tang
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
,
Timothy O’Sullivan
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
2   Westmead Clinical School of Medicine, The University of Sydney, Sydney, Australia
,
Anthony Whitfield
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
2   Westmead Clinical School of Medicine, The University of Sydney, Sydney, Australia
,
Oliver Cronin
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
2   Westmead Clinical School of Medicine, The University of Sydney, Sydney, Australia
,
Varan Perananthan
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
,
Clarence Kerrison
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
,
Eric Y. Lee
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
,
Nicholas G. Burgess 
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
2   Westmead Clinical School of Medicine, The University of Sydney, Sydney, Australia
,
Michael J. Bourke
1   Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
2   Westmead Clinical School of Medicine, The University of Sydney, Sydney, Australia
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Abstract

Background Diverticular peroral endoscopic myotomy (POEM) is an alternative to surgery for the management of symptomatic thoracic esophageal diverticula. Conventionally, this requires proximal tunnel formation but a direct approach may simplify the technique. Herein, we report the outcomes of direct diverticular-POEM (DD-POEM).

Methods We conducted a single-center prospective observational study evaluating DD-POEM. This involved a direct approach to the diverticulum. Success was defined as an Eckardt score of ≤ 3 without the need for reintervention.

Results 10 patients underwent DD-POEM (median age 72 years; interquartile range [IQR] 14.3; male 60 % [n = 6]). Median diverticulum size was 40 mm (IQR 7.5) and median location was 35 cm from the incisors (IQR 8.3). Five patients (50 %) had an underlying dysmotility disorder. The median procedure duration was 60 minutes (IQR 28.8). There were no adverse events. The median hospital stay was 1 day (IQR 0.75). The pre-procedure median Eckardt score of 6 (IQR 4) significantly improved to 0 (IQR 0.75; P < 0.001) at a median follow-up of 14.5 months (IQR 13.8). Success was achieved in all patients.

Conclusions DD-POEM was a safe technique for the management of thoracic esophageal diverticula. Owing to its simplicity and excellent performance it should be further evaluated for the treatment of this disorder.

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Publication History

Received: 23 May 2023

Accepted after revision: 17 August 2023

Article published online:
18 October 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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