Zenker’s peroral endoscopic myotomy for management of large Zenker’s diverticulum

Linda Y. Zhang; Oscar Hernández Mondragón; Mathieu Pioche; Steven N. Steinway; Jose Nieto; Michael B. Ujiki; Vanessa N. VanDruff; Raymond E. Kim; Andrew Canakis; Marcel Tantau; Alina Tantau; Anamaria Pop; Jérémie Jacques; Michael Lajin; Pankaj Desai; Apurva Shrigiriwar; Michael Bejjani; Nikhil A. Kumta; Mouen A. Khashab

doi:10.1055/a-2025-0715

Endoscopy, Table of Contents

Endoscopy 2023; 55(06): 501-507
DOI: 10.1055/a-2025-0715

Original article

Zenker’s peroral endoscopic myotomy for management of large Zenker’s diverticulum

Linda Y. Zhang

¹Johns Hopkins Medicine, Baltimore, Maryland, United States

,

Oscar Hernández Mondragón

²National Medical Center Century XXI, Mexico City, Mexico

,

Mathieu Pioche

³Hospital Edouard Herriot, Lyon, Rhone-Alpes, France

,

Steven N. Steinway

¹Johns Hopkins Medicine, Baltimore, Maryland, United States

,

Jose Nieto

⁴Borland Groover, Jacksonville, Florida, United States

,

Michael B. Ujiki

⁵NorthShore University Health System, Evanston, Illinois, United States

,

Vanessa N. VanDruff

⁵NorthShore University Health System, Evanston, Illinois, United States

,

Raymond E. Kim

⁶Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland, United States

,

Andrew Canakis

⁶Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland, United States

,

Marcel Tantau

⁷“Prof Dr Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Cluj, Romania

,

Alina Tantau

⁸Gastroenterology and Hepatology Medical Center, Cluj-Napoca, Cluj, Romania

,

Anamaria Pop

⁸Gastroenterology and Hepatology Medical Center, Cluj-Napoca, Cluj, Romania

,

Jérémie Jacques

⁹Hôpital Dupuytren, Servìce de Gastroentérologie, Limoges, France

,

Michael Lajin

¹⁰Sharp HealthCare, San Diego, California, United States

,

Pankaj Desai

¹¹Department of Gastroenterology, Endoscopy Unit, SIDS Hospitals, Surat, India

,

Apurva Shrigiriwar

¹Johns Hopkins Medicine, Baltimore, Maryland, United States

,

Michael Bejjani

¹Johns Hopkins Medicine, Baltimore, Maryland, United States

,

Nikhil A. Kumta

¹²Icahn School of Medicine at Mount Sinai, New York, New York, United States

,

Mouen A. Khashab

¹Johns Hopkins Medicine, Baltimore, Maryland, United States

› Author Affiliations

Abstract

Background Zenker’s diverticulum peroral endoscopic myotomy (zPOEM) is a minimally invasive treatment strategy for Zenker’s diverticulum, with excellent results for management of small-to-moderate Zenker’s diverticulum. We evaluated its use in the management of large Zenker’s diverticulum.

Methods This was a retrospective multicenter cohort study across 11 international centers including adult patients with large Zenker’s diverticulum ≥ 40 mm treated by zPOEM between March 2017 and March 2022. The primary outcome was clinical success (dysphagia score ≤ 1 without need for further intervention). Secondary outcomes included technical success (complete myotomy as intended), adverse events (AEs), and rate of recurrence.

Results 83 patients (male 62.7 %, mean age 72.6 [SD 11.5] years) underwent zPOEM for treatment of large Zenker’s diverticulum (median size 50 mm, interquartile range [IQR] 41–55 mm, range 40–80 mm). The zPOEM procedure was technically successful in 82 patients (98.8 %), with a mean procedure time of 48.7 (SD 23.2) minutes. Clinical success was achieved in 71 patients (85.5 %). Median (IQR) symptom scores improved significantly from baseline for dysphagia (2 [2] [3] vs. 0 [0–2]; P < 0.001), regurgitation (3 [2] [3] [4] vs. 0 [0–0]; P < 0.001), and respiratory symptoms (2 [0–3] vs. 0 [0–0]; P < 0.001). Among patients achieving clinical success, only one recurrence (1.4 %) was recorded during a median follow-up of 12.2 months (IQR 3–28). Post-procedure AEs, all mild to moderate, occurred in four patients (4.8 %).

Conclusion: This study demonstrated safe and effective use of zPOEM in the management of large Zenker’s diverticulum.

Full Text

References

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