Sarah S Al Ghamdi1, Jad Farha1, Robert A Moran2, Mathieu Pioche3, Frédéric Moll3, Dennis J Yang4, Oscar V Hernández Mondragón5, Michael Ujiki6, Harry Wong6, Alina Tantau7, Alireza Sedarat8, M Phillip Fejleh8, Kenneth Chang9, David P Lee9, Jose M Nieto10, Sherif Andrawes11, Gregory G Ginsberg12, Monica Saumoy12, Amol Bapaye13, Parag Dashatwar13, Mohamad Aghaie Meybodi1, Ariana C Lopez1, Omid Sanaei1, Muhammad N Yousaf14, Manol Jovani1, Yervant Ichkhanian1, Olaya I Brewer Gutierrez1, Vivek Kumbhari1, Ashli K O'Rourke15, Eric J Lentsch15, B Joseph Elmunzer2, Mouen A Khashab1. 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
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. Thieme. All rights reserved.
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. Thieme. All rights reserved.