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Outcomes after per-oral endoscopic myotomy for Zenker’s diverticula (Z-POEM) and correlation with impedance planimetry (FLIP)

  • 2023 SAGES Oral
  • Published:
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Abstract

Introduction

Zenker’s diverticulum (ZD) is a false pulsion diverticulum of the cervical esophagus. It is typically found in older adults and manifests with dysphagia. The purpose of this study is to describe our experience with Per-oral endoscopic myotomy for Zenker’s (Z-POEM) and intraoperative impedance planimetry (FLIP).

Methods

We performed a single institution retrospective review of patients undergoing Z-POEM in a prospective database between 2014 and 2022. Upper esophageal sphincter (UES) distensibility index (DI, mm2/mmHg) was measured by FLIP before and after myotomy. The primary outcome was clinical success. Secondary outcomes included technical failure, adverse events, and quality of life as assessed by the gastroesophageal health-related quality of life (GERD-HRQL), reflux severity index (RSI), and dysphagia score. A statistical analysis of DI was done with the paired t-test (p < 0.05).

Results

Fifty-four patients underwent Z-POEM, with FLIP measurements available in 30 cases. We achieved technical success and clinical success in 54/54 (100%) patients and 46/54 patients (85%), respectively. Three patients (6%) experienced contained leaks. Three patients were readmitted: one for aforementioned contained leak, one for dysphagia, and one post-operative pneumonia. Three patients with residual dysphagia underwent additional endoscopic procedures, all of whom had diverticula > 4 cm. Following myotomy, mean DI increased by 2.0 ± 1.7 mm2/mmHg (p < 0.001). In those with good clinical success, change in DI averaged + 1.6 ± 1.1 mm2/mmHg. Significant improvement was found in RSI and GERD-HRQL scores, but not dysphagia score.

Conclusion

Z-POEM is a safe and feasible for treatment of ZD. We saw zero cases of intraoperative abandonment. We propose that large diverticula (> 4 cm) are a risk factor for poor outcomes and may require additional endoscopic procedures. An improvement in DI is expected after myotomy, however, the ideal range is still not known.

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Funding

There was no funding or financial support for this study.

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Authors and Affiliations

  1. Department of Surgery, NorthShore University Health System, GCSI Suite B665, 2650 Ridge Ave, Evanston, IL, 60201, USA

    Simon Y. W. Che, Stephanie Joseph, Kristine Kuchta, Julia R. Amundson, Vanessa N. VanDruff, Shun Ishii, Christopher J. Zimmermann, Herbert M. Hedberg & Michael B. Ujiki

  2. Department of Surgery, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL, 60637, USA

    Julia R. Amundson, Vanessa N. VanDruff & Michael B. Ujiki

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  1. Simon Y. W. Che
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  2. Stephanie Joseph
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  3. Kristine Kuchta
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  4. Julia R. Amundson
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  6. Shun Ishii
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  9. Michael B. Ujiki
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Correspondence to Simon Y. W. Che.

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Disclosures

Michael B. Ujiki is a scientific advisory board member for Boston Scientific and Apollo, a consultant and speaker for WL Gore and Associates, and a speaker for Medtronic. Simon YW Che, Stephanie Joseph, Kristine Kuchta, Julia R. Amundson,Vanessa N. VanDruff, Shun Ishii, Christopher J. Zimmermann, Herbert M. Hedberg, Michael B. Ujiki have no conflicts of interest or financial ties to disclose.

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This manuscript was accepted for an oral quick shot presentation at the 2023 Society or American Gastrointestinal and Endoscopic Surgeons (SAGES) Conference on March 30, 2023 in Montreal, Quebec, Canada.

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Che, S.Y.W., Joseph, S., Kuchta, K. et al. Outcomes after per-oral endoscopic myotomy for Zenker’s diverticula (Z-POEM) and correlation with impedance planimetry (FLIP). Surg Endosc 38, 957–963 (2024). https://doi.org/10.1007/s00464-023-10512-0

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