Juliana Yang1, Stephanie Novak2, Michael Ujiki2, Óscar Hernández3, Pankaj Desai4, Petros Benias5, David Lee6, Kenneth Chang6, Bertrand Brieau7, Maximilien Barret7, Nikhil Kumta8, Xianhui Zeng9, Bing Hu9, Konstantinos Delis10, Mouen A Khashab1. 1. Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA. 2. Department of Surgery, Section of Minimally Invasive Surgery, North Shore University Health System, Evanston, Illinois, USA. 3. Departamento de Endoscopia, Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México. 4. Surat Institute of Digestive Sciences, Surat, India. 5. Division of Gastroenterology, Department of Medicine, Hofstra Northwell School of Medicine, Northwell Health System, North Shore University Hospital, Manhasset, New York, USA. 6. H.H. Chao Comprehensive Digestive Disease Center, Division of Gastroenterology & Hepatology, Department of Medicine, UC Irvine School of Medicine, Irvine, California, USA. 7. Service de gastroentérologie, Hôpital Cochin, Maitre de Conférence des Universités, Praticien Hospitalier Université Paris Descartes, Paris, France. 8. Division of Gastroenterology, Mount Sinai Medical Center, New York, New York, USA. 9. Department of Gastroenterology, West China Hospital, Sichuan University, Sichuan, China. 10. Department of Gastroenterology, Metropolitan Hospital, Neo Faliro, Piraeus, Greece.
Abstract
BACKGROUND AND AIMS: The novel use of peroral endoscopic myotomy (POEM) in the treatment of Zenker's diverticulum (ZD) was recently described in case reports. The aim of this study is to report a multicenter experience with the POEM technique in the management of ZD. METHODS: This is a multicenter international retrospective study involving 10 centers. The Zenker's POEM technique was performed using principles of submucosal endoscopy. RESULTS: Seventy-five patients (73.3 ± 1.2 years, 33 women) were included with a mean Charleson comorbidity index of 4 ± .2. The mean size of ZD was 31.3 ± 1.6 mm (range, 10-89). The overall technical success rate was 97.3% (73/75). There were 2 technical failures because of the inability to locate the septum and failed tunnel creation. Adverse events occurred in 6.7% (5/75): 1 bleed (mild) conservatively managed and 4 perforations (1 severe, 3 moderate). The mean procedure time was 52.4 ± 2.9 minutes, and mean length of hospital stay was 1.8 ± .2 days. Clinical success was achieved in 92% (69/75) with a decrease in mean dysphagia score from 1.96 to .25 (P < .0001). The median length of follow-up was 291.5 days (interquartile range, 103.5-436). At the 12-month follow-up, 1 patient reported symptom recurrence. CONCLUSIONS: Endoscopic management of ZD using the POEM technique is novel and feasible with promising efficacy and safety results. Long-term follow-up is needed to ensure durability of response. In addition, comparative studies with other treatment modalities are warranted.
BACKGROUND AND AIMS: The novel use of peroral endoscopic myotomy (POEM) in the treatment of Zenker's diverticulum (ZD) was recently described in case reports. The aim of this study is to report a multicenter experience with the POEM technique in the management of ZD. METHODS: This is a multicenter international retrospective study involving 10 centers. The Zenker's POEM technique was performed using principles of submucosal endoscopy. RESULTS: Seventy-five patients (73.3 ± 1.2 years, 33 women) were included with a mean Charleson comorbidity index of 4 ± .2. The mean size of ZD was 31.3 ± 1.6 mm (range, 10-89). The overall technical success rate was 97.3% (73/75). There were 2 technical failures because of the inability to locate the septum and failed tunnel creation. Adverse events occurred in 6.7% (5/75): 1 bleed (mild) conservatively managed and 4 perforations (1 severe, 3 moderate). The mean procedure time was 52.4 ± 2.9 minutes, and mean length of hospital stay was 1.8 ± .2 days. Clinical success was achieved in 92% (69/75) with a decrease in mean dysphagia score from 1.96 to .25 (P < .0001). The median length of follow-up was 291.5 days (interquartile range, 103.5-436). At the 12-month follow-up, 1 patient reported symptom recurrence. CONCLUSIONS: Endoscopic management of ZD using the POEM technique is novel and feasible with promising efficacy and safety results. Long-term follow-up is needed to ensure durability of response. In addition, comparative studies with other treatment modalities are warranted.
Authors: Charlotte Juin; Maximilien Barret; Arthur Belle; Einas Abouali; Sarah Leblanc; Ammar Oudjit; Anthony Dohan; Romain Coriat; Stanislas Chaussade Journal: Endosc Int Open Date: 2020-06-16
Authors: Abdulwahid M Salih; Twana M Ameen; Safeen O Mahmood; Fahmi H Kakamad; Bahman L Fathulla; Tomas M Mikael; Imad J Habibullah; Shvan H Mohammed; Rawezh Q Salih; Suhaib H Kakamad Journal: Int J Surg Case Rep Date: 2020-05-29