Shaimaa Elkholy1, Mohamed El-Sherbiny2, Roberto Delano-Alonso3, Jose de Jesus Herrera-Esquivel3, Carlos Valenzuela-Salazar3, Andres Rodriguez-Parra3, Ignacio Del Rio-Suarez3, Jorge Vargas-Madrigal4, Tarik Akar5, Süleyman Günay6, Zaher Houmani7, Bahri Abayli8, Mohammad A Elkady9, Ahmed Alzamzamy10, Mahmoud Wahba2, Ahmad Madkour11, Reem Ezzat Mahdy12, Kareem Essam2, Mouen A Khashab13. 1. Gastroenterology Division, Internal Medicine Department, Faculty of Medicine, Cairo University, Kasr Alainy Street Cairo, Cairo, 11311, Egypt. shuma50082@gmail.com. 2. Gastroenterology Division, Internal Medicine Department, Faculty of Medicine, Cairo University, Kasr Alainy Street Cairo, Cairo, 11311, Egypt. 3. Gastroenterology Department, Manuel Gea Gonzalez General Hospital, Mexico City, Mexico. 4. Gastroenterology Department, Enrique Baltodano Briceno Hospital, Liberia, Costa Rica. 5. Gastroenterology Department, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey. 6. Gastroenterology Department, Ataturk Education and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey. 7. Gastroenterology Department, Faculty of Medicine, Najdeh Hospital, Lebanese University, Beirut, Lebanon. 8. Gastroenterology Department, Seyhan State Hospital, Adana, Turkey. 9. Gastroenterology and Hepatology Department, Theodor Bilharz Research Institute, Cairo, Egypt. 10. Gastroenterology and Hepatology Department, Military Medical Academy, Cairo, Egypt. 11. Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt. 12. Gastroenterology Division, Internal Medicine Department, Faculty of Medicine, Assuit University, Assuit, Egypt. 13. Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, USA.
Abstract
BACKGROUND: Peroral endoscopic myotomy for the treatment of Zenker's diverticulum (Z-POEM) is a novel technique that has been described in several recent reports. This method utilizes the third space (submucosal layer) to create a tunnel to facilitate complete visualization of the septum and hence cutting it entirely. Conventional endoscopic septotomy carries the risk of recurrence due to incomplete visualization of the septum. While surgical correction is a risky and lengthy procedure in old comorbid patients with Zenker's diverticulum. The aim of this study is to assess the efficacy and safety of Z-POEM. METHODS: The study enrolled 24 patients diagnosed with Zenker's diverticulum (ZD) who underwent Z-POEM at seven independent endoscopy centers in five different countries. RESULTS: Mean patient age ± standard deviation (SD) was 74.3 ± 11 years. Most of the patients were males (n = 20, 83.3%); four (16.7%) were females. More than 50% of the patients (n = 14, 58.3%) had associated comorbidities. The mean size of the diverticula was 4 cm (range 2-7 cm). The Kothari-Haber Score was used to assess clinical symptoms; values ranged from 6 to 14 (median = 9). We achieved 100% technical success with a median procedure time of 61 min and no adverse events. Median hospital stay was 1 day (range 1-5 days). There is a significant reduction in the Kothari-Haber Score after Z-POEM (P < 0.0001). Technical success was achieved in 100% of the patients. Clinical success was achieved in 23/24 (95.8%) of the patients with a median follow-up of 10 months (range 6-24 months). CONCLUSION: Z-POEM is a safe and effective modality for managing ZD.
BACKGROUND: Peroral endoscopic myotomy for the treatment of Zenker's diverticulum (Z-POEM) is a novel technique that has been described in several recent reports. This method utilizes the third space (submucosal layer) to create a tunnel to facilitate complete visualization of the septum and hence cutting it entirely. Conventional endoscopic septotomy carries the risk of recurrence due to incomplete visualization of the septum. While surgical correction is a risky and lengthy procedure in old comorbid patients with Zenker's diverticulum. The aim of this study is to assess the efficacy and safety of Z-POEM. METHODS: The study enrolled 24 patients diagnosed with Zenker's diverticulum (ZD) who underwent Z-POEM at seven independent endoscopy centers in five different countries. RESULTS: Mean patient age ± standard deviation (SD) was 74.3 ± 11 years. Most of the patients were males (n = 20, 83.3%); four (16.7%) were females. More than 50% of the patients (n = 14, 58.3%) had associated comorbidities. The mean size of the diverticula was 4 cm (range 2-7 cm). The Kothari-Haber Score was used to assess clinical symptoms; values ranged from 6 to 14 (median = 9). We achieved 100% technical success with a median procedure time of 61 min and no adverse events. Median hospital stay was 1 day (range 1-5 days). There is a significant reduction in the Kothari-Haber Score after Z-POEM (P < 0.0001). Technical success was achieved in 100% of the patients. Clinical success was achieved in 23/24 (95.8%) of the patients with a median follow-up of 10 months (range 6-24 months). CONCLUSION: Z-POEM is a safe and effective modality for managing ZD.