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CC BY-NC-ND 4.0 · Journal of Digestive Endoscopy 2020; 11(03): 209-214
DOI: 10.1055/s-0040-1716584
Research Article

Z-POEM as a Treatment Option for Zenker’s Diverticulum: Our Experience at a Tertiary Care Centre in India

Pankaj N. Desai
1   Department of Endoscopy and Endosonography, Surat Institute of Digestive Sciences (SIDS), Surat, Gujarat, India
,
Mayank V. Kabrawala
1   Department of Endoscopy and Endosonography, Surat Institute of Digestive Sciences (SIDS), Surat, Gujarat, India
,
Chintan N. Patel
1   Department of Endoscopy and Endosonography, Surat Institute of Digestive Sciences (SIDS), Surat, Gujarat, India
,
Rajiv M. Mehta
2   Department of Gastroenterology, Surat Institute of Digestive Sciences (SIDS), Surat, Gujarat, India
,
Subhash K. Nandwani
2   Department of Gastroenterology, Surat Institute of Digestive Sciences (SIDS), Surat, Gujarat, India
,
Ritesh Prajapati
2   Department of Gastroenterology, Surat Institute of Digestive Sciences (SIDS), Surat, Gujarat, India
,
Nisharg Patel
2   Department of Gastroenterology, Surat Institute of Digestive Sciences (SIDS), Surat, Gujarat, India
,
Krishna K. Parekh
3   Department of Clinical Research, Surat Institute of Digestive Sciences (SIDS), Surat, Gujarat, India
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Abstract

Background This study was aimed to evaluate efficacy and safety of Z–peroral endoscopic myotomy (Z-POEM; submucosal tunneling endoscopic myotomy) for Zenker’s diverticulum (ZD).

Methods This is a retrospective study at a single tertiary care center in India. The Z-POEM technique was performed using principles of submucosal tunneling endoscopy with prior experience from POEM technique for achalasia cardia

Results Sixteen patients (male, 62.5%; mean age, 73.2 ± 5.2 years) were included with a mean Charleson’s comorbidity index of 4.32. The mean size of ZD was 34.8 ± 10.0 mm. The technical success rate was 100%. Clinical success was achieved in 100% (16/16) with a decrease in mean dysphagia score from 2.9 to 0.2 (p <0.0001). The mean procedure time was 47 ± 7.9 minutes and mean length of septotomy was 31.9 ± 9.4 mm. The mean length of hospital stay was 1.2 ± 0.4 days. No major adverse events were noted. Capnomediastinum was noted in two cases on follow-up Gastrografin study after 24 hours (12.5%). This did not merit any treatment. One patient had intraprocedural bleed which was controlled easily. At the 18-month follow-up, two (12.5%) patients reported dysphagia recurrence (Dakkak and Bennett score 1) but did not require repeat intervention.

Conclusion Endoscopic management of ZD using the POEM technique is a promising technique with improved efficacy and safety. However, long-term follow-up is needed to ensure the durability of response.

Keywords

septotomy - submucosal tunneling endoscopy - Zenker’s diverticulum - Z-POEM


Publication History

Article published online:
14 September 2020

© .

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

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