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Per Oral Endoscopic Myotomy for the Management of Large Esophageal Diverticula (D-POEM): Safe and Effective Modality for Complete Septotomy

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Abstract

With the advent of the technique of sub-mucosal tunnelling, peroral endoscopic myotomy (POEM) has been used for the treatment of esophageal diverticulum, which otherwise is a recurring problem with conventional flexible endoscopic treatment due to incompleteness of septotomy. This study reports our experience of the use of diverticular POEM (D-POEM) technique in the management of large esophageal diverticulum. This is a retrospective study of prospectively maintained database including all consecutive patients with symptomatic esophageal diverticulum presenting at a tertiary care academic center. D-POEM was performed using the technique of submucosal tunnelling and septotomy. Besides baseline parameters, technical success, clinical success, size of diverticula, procedure time, complications and symptom recurrence on follow up were noted. A total of five patients (4 males; median age 72) were included with an average Charlson comorbidity index of 3.2 ± 0.8. Of them, three had Zenker’s while two had epiphrenic diverticulum. The median symptom duration was 12 months with a mean diverticulum size of 68.8 ± 1.9 mm. The mean procedure time was 64.80 ± 12.6 min. with a mean septotomy/myotomy length of 79.44 ± 12.2 mm. Minor adverse events were noted intra-procedure in two cases. Clinical success achieved in all cases with a significant mean dysphagia score reduction from 2.20 to 0.20 post procedure (p = 0.011). On a median follow up of 280 days (range 98–330), none had recurrence of symptoms. Our data highlighted that complete septotomy by D-POEM technique can be achieved for the management of large esophageal diverticulum and is safe and effective.

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Acknowledgements

Dr JS and Dr HSM has contributed equally for the work

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Authors and Affiliations

  1. Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India

    Jayanta Samanta, Harshal S. Mandavdhare, Naveen Kumar, Pankaj Gupta, Usha Dutta & Rakesh Kochhar

  2. Department of Pharmacology, PGIMER, Chandigarh, India

    Praveen Kumar-M

  3. Department of Anaesthesiology, PGIMER, Chandigarh, India

    Anudeep Jafra & Rajeev Chauhan

  4. Department of Surgery, PGIMER, Chandigarh, India

    K. Hemanth Kumar & Harjeet Singh

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Samanta, J., Mandavdhare, H.S., Kumar, N. et al. Per Oral Endoscopic Myotomy for the Management of Large Esophageal Diverticula (D-POEM): Safe and Effective Modality for Complete Septotomy. Dysphagia 37, 84–92 (2022). https://doi.org/10.1007/s00455-021-10252-0

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