Zenker’s peroral endoscopic myotomy, or flexible or rigid septotomy for Zenker’s diverticulum: a multicenter retrospective comparison

Author:

Al Ghamdi Sarah S.1ORCID,Farha Jad1,Moran Robert A.2,Pioche Mathieu3,Moll Frédéric3,Yang Dennis J.4,Hernández Mondragón Oscar V.5,Ujiki Michael6,Wong Harry6,Tantau Alina7,Sedarat Alireza8,Fejleh M. Phillip8,Chang Kenneth9,Lee David P.9,Nieto Jose M.10,Andrawes Sherif11,Ginsberg Gregory G.12,Saumoy Monica12,Bapaye Amol13ORCID,Dashatwar Parag13,Aghaie Meybodi Mohamad1,Lopez Ariana C.1,Sanaei Omid1,Yousaf Muhammad N.14,Jovani Manol1ORCID,Ichkhanian Yervant1,Brewer Gutierrez Olaya I.1ORCID,Kumbhari Vivek1,O’Rourke Ashli K.15,Lentsch Eric J.15,Elmunzer B. Joseph2,Khashab Mouen A.1

Affiliation:

1. Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States

2. Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, United States

3. Gastroenterology, Edouard Herriot Hospital, Lyon, France

4. Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, United States

5. Division of Endoscopy, Specialties Hospital, National Medical Center Century XXI, Mexico City, Mexico

6. Division of Minimally Invasive Surgery, NorthShore’s Grainger Center for Simulation and Innovation, Evanston, Illinois, United States

7. Department of Gastroenterology, the 4th Medical Clinic, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania

8. Ronald Reagan UCLA Medical Center, UCLA Medical Center, Los Angeles, California, United States

9. H.H. Chao Comprehensive Digestive Disease Center, University of California, Irvine Medical Center, Irvine, California, United States

10. Borland Groover Clinic Advance Therapeutic Endoscopy Center and Baptist Medical Center, Jacksonville, Florida, United States

11. Division of Gastroenterology and Hepatology, Staten Island University Hospital – Northwell Health, Staten Island, New York, United States

12. Endoscopic Services, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, United States

13. Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India

14. Medstar Union Memorial Hospital, Columbia, Maryland, United States

15. Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, United States

Abstract

Abstract Background Treatment of Zenker’s diverticulum has evolved from open surgery to endoscopic techniques, including flexible and rigid endoscopic septotomy, and more recently, peroral endoscopic myotomy (Z-POEM). This study compared the effectiveness of flexible and rigid endoscopic septotomy with that of Z-POEM. Methods Consecutive patients who underwent endoscopic septotomy (flexible/rigid) or Z-POEM for Zenker’s diverticulum between 1/2016 and 9/2019 were included. Primary outcomes were clinical success (decrease in Dakkak and Bennett dysphagia score to ≤ 1), clinical failure, and clinical recurrence. Secondary outcomes included technical success and rate/severity of adverse events. Results 245 patients (110 females, mean age 72.63 years, standard deviation [SD] 12.37 years) from 12 centers were included. Z-POEM was the most common management modality (n = 119), followed by flexible (n = 86) and rigid (n = 40) endoscopic septotomy. Clinical success was 92.7 % for Z-POEM, 89.2 % for rigid septotomy, and 86.7 % for flexible septotomy (P = 0.26). Symptoms recurred in 24 patients (15 Z-POEM during a mean follow-up of 282.04 [SD 300.48] days, 6 flexible, 3 rigid [P = 0.47]). Adverse events occurred in 30.0 % rigid septotomy patients, 16.8 % Z-POEM patients, and 2.3 % flexible septotomy patients (P < 0.05). Conclusions There was no difference in outcomes between the three treatment approaches for symptomatic Zenker’s diverticulum. Rigid endoscopic septotomy was associated with the highest rate of complications, while flexible endoscopic septotomy appeared to be the safest. Recurrence following Z-POEM was similar to flexible and rigid endoscopic septotomy. Prospective studies with long-term follow-up are required.

Publisher

Georg Thieme Verlag KG

Subject

Gastroenterology

Reference29 articles.

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2. Zenker’s diverticulum: exploring treatment options;A Bizzotto;Acta Otorhinolaryngol Ital,2013

3. Principles of surgical treatment of Zenker diverticulum;A Constantin;J Med Life,2012

4. Current practice in pharyngeal pouch surgery in England and Wales;C B Koay;Ann R Coll Surg Engl,1997

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