TY - JOUR
T1 - Zenker's peroral endoscopic myotomy, or flexible or rigid septotomy for Zenker's diverticulum
T2 - A multicenter retrospective comparison
AU - Al Ghamdi, Sarah S.
AU - Farha, Jad
AU - Moran, Robert A.
AU - Pioche, Mathieu
AU - Moll, Frédéric
AU - Yang, Dennis J.
AU - Hernández Mondragón, Oscar V.
AU - Ujiki, Michael
AU - Wong, Harry
AU - Tantau, Alina
AU - Sedarat, Alireza
AU - Fejleh, M. Phillip
AU - Chang, Kenneth
AU - Lee, David P.
AU - Nieto, Jose M.
AU - Andrawes, Sherif
AU - Ginsberg, Gregory G.
AU - Saumoy, Monica
AU - Bapaye, Amol
AU - Dashatwar, Parag
AU - Aghaie Meybodi, Mohamad
AU - Lopez, Ariana C.
AU - Sanaei, Omid
AU - Yousaf, Muhammad N.
AU - Jovani, Manol
AU - Ichkhanian, Yervant
AU - Brewer Gutierrez, Olaya I.
AU - Kumbhari, Vivek
AU - O'Rourke, Ashli K.
AU - Lentsch, Eric J.
AU - Elmunzer, B. Joseph
AU - Khashab, Mouen A.
N1 - Funding Information:
M.A. Khashab is a consultant for Boston Scientific, Olympus, Medtro-nic, GI Supply, and Triton. B.J. Elmunzer is a consultant for Takeda Pharmaceuticals. V. Kumbhari is a consultant for Apollo Endosurgery, Boston Scientific, Medtronic, FuijFilm, Pentax Medical, ReShape Life-sciences, and Obalon, and has received research support from ERBE and Apollo Endosurgery. D.J. Yang is a consultant for Boston Scientific, Lumendi, and Steris. G.G. Ginsberg is a consultant for Olympus Inc. and Boston Scientific. M. Ujiki is a consultant for Olympus, Boston Scientific, and Cook, and receives grant funding from Medtronic; he is also a speaker for Medtronic and Gore, and receives fellowship funding from Boston Scientific. J.M. Nieto is a consultant for Boston Scientific and ERBE. S. Andrawes is a consultant for Olympus. The remaining authors declare that they have no conflict of interest.
Publisher Copyright:
© 2022. Thieme. All rights reserved.
PY - 2022/4/1
Y1 - 2022/4/1
N2 - 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.
AB - 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.
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U2 - 10.1055/a-1518-7223
DO - 10.1055/a-1518-7223
M3 - Article
C2 - 34198355
AN - SCOPUS:85109395241
SN - 0013-726X
VL - 54
SP - 345
EP - 351
JO - Endoscopy
JF - Endoscopy
IS - 4
ER -