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Peroral endoscopic myotomy as treatment for Zenker’s diverticulum (Z-POEM): a multi-center international study

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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.

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Authors and Affiliations

  1. Gastroenterology Division, Internal Medicine Department, Faculty of Medicine, Cairo University, Kasr Alainy Street Cairo, Cairo, 11311, Egypt

    Shaimaa Elkholy, Mohamed El-Sherbiny, Mahmoud Wahba & Kareem Essam

  2. Gastroenterology Department, Manuel Gea Gonzalez General Hospital, Mexico City, Mexico

    Roberto Delano-Alonso, Jose de Jesus Herrera-Esquivel, Carlos Valenzuela-Salazar, Andres Rodriguez-Parra & Ignacio Del Rio-Suarez

  3. Gastroenterology Department, Enrique Baltodano Briceno Hospital, Liberia, Costa Rica

    Jorge Vargas-Madrigal

  4. Gastroenterology Department, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey

    Tarik Akar

  5. Gastroenterology Department, Ataturk Education and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey

    Süleyman Günay

  6. Gastroenterology Department, Faculty of Medicine, Najdeh Hospital, Lebanese University, Beirut, Lebanon

    Zaher Houmani

  7. Gastroenterology Department, Seyhan State Hospital, Adana, Turkey

    Bahri Abayli

  8. Gastroenterology and Hepatology Department, Theodor Bilharz Research Institute, Cairo, Egypt

    Mohammad A. Elkady

  9. Gastroenterology and Hepatology Department, Military Medical Academy, Cairo, Egypt

    Ahmed Alzamzamy

  10. Endemic Medicine Department, Faculty of Medicine, Helwan University, Cairo, Egypt

    Ahmad Madkour

  11. Gastroenterology Division, Internal Medicine Department, Faculty of Medicine, Assuit University, Assuit, Egypt

    Reem Ezzat Mahdy

  12. Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, USA

    Mouen A. Khashab

Authors
  1. Shaimaa Elkholy
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  2. Mohamed El-Sherbiny
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  3. Roberto Delano-Alonso
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  4. Jose de Jesus Herrera-Esquivel
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  5. Carlos Valenzuela-Salazar
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  6. Andres Rodriguez-Parra
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  7. Ignacio Del Rio-Suarez
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  8. Jorge Vargas-Madrigal
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  9. Tarik Akar
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  10. Süleyman Günay
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  15. Mahmoud Wahba
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  17. Reem Ezzat Mahdy
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  18. Kareem Essam
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  19. Mouen A. Khashab
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Corresponding author

Correspondence to Shaimaa Elkholy.

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Ethical Statement

This study had been approved from the ethical comitte of the gastroenterology division of the internal medicine department in the faculty of medicine of Cairo University.

Conflict of interest

Mouen A. Khaskab: consultant and medical advisory board for Olympus and Boston Scientific; consultant for Medtronic. All other authors have no conflicts of interest or financial ties to disclose.

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Supplementary Information

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Supplementary file1. This video illustrates the steps of the Z-POEM procedure: a identification of the septum with the narrow esophageal lumen on the right side and the wider diverticular lumen on the left. b Submucosal blue bleb is formed at a site proximal to the septum. c The tunnel was opened using a Hybrid Knife I-type. d Dissection of the submucosa on either side of the septum. e Cutting of the septum using a Hybrid Knife O-type. f Extension of the myotomy into the esophageal muscles. g Closure of the tunnel opening with endoclips. (MOV 230298 KB)

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Elkholy, S., El-Sherbiny, M., Delano-Alonso, R. et al. Peroral endoscopic myotomy as treatment for Zenker’s diverticulum (Z-POEM): a multi-center international study. Esophagus 18, 693–699 (2021). https://doi.org/10.1007/s10388-020-00809-7

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  • DOI: https://doi.org/10.1007/s10388-020-00809-7

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