Article Dans Une Revue Endoscopy Année : 2023

Zenker’s peroral endoscopic myotomy for management of large Zenker’s diverticulum

Oscar Hernández Mondragón
  • Fonction : Auteur
Steven Steinway
  • Fonction : Auteur
Michael Ujiki
  • Fonction : Auteur
Vanessa Vandruff
  • Fonction : Auteur
Raymond Kim
  • Fonction : Auteur
Andrew Canakis
Marcel Tantau
  • Fonction : Auteur
Alina Tantau
  • Fonction : Auteur
Anamaria Pop
  • Fonction : Auteur
Jérémie Jacques
Michael Lajin
Pankaj Desai
  • Fonction : Auteur
Apurva Shrigiriwar
  • Fonction : Auteur
Michael Bejjani
  • Fonction : Auteur
Nikhil Kumta
  • Fonction : Auteur
Mouen Khashab
  • Fonction : Auteur

Résumé

Abstract Background Zenker’s diverticulum peroral endoscopic myotomy (zPOEM) is a minimally invasive treatment strategy for Zenker’s diverticulum, with excellent results for management of small-to-moderate Zenker’s diverticulum. We evaluated its use in the management of large Zenker’s diverticulum. Methods This was a retrospective multicenter cohort study across 11 international centers including adult patients with large Zenker’s diverticulum ≥ 40 mm treated by zPOEM between March 2017 and March 2022. The primary outcome was clinical success (dysphagia score ≤ 1 without need for further intervention). Secondary outcomes included technical success (complete myotomy as intended), adverse events (AEs), and rate of recurrence. Results 83 patients (male 62.7 %, mean age 72.6 [SD 11.5] years) underwent zPOEM for treatment of large Zenker’s diverticulum (median size 50 mm, interquartile range [IQR] 41–55 mm, range 40–80 mm). The zPOEM procedure was technically successful in 82 patients (98.8 %), with a mean procedure time of 48.7 (SD 23.2) minutes. Clinical success was achieved in 71 patients (85.5 %). Median (IQR) symptom scores improved significantly from baseline for dysphagia (2 2 3 vs. 0 [0–2]; P < 0.001), regurgitation (3 2 3 4 vs. 0 [0–0]; P < 0.001), and respiratory symptoms (2 [0–3] vs. 0 [0–0]; P < 0.001). Among patients achieving clinical success, only one recurrence (1.4 %) was recorded during a median follow-up of 12.2 months (IQR 3–28). Post-procedure AEs, all mild to moderate, occurred in four patients (4.8 %). Conclusion: This study demonstrated safe and effective use of zPOEM in the management of large Zenker’s diverticulum.

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Dates et versions

hal-04601561 , version 1 (05-06-2024)

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Linda Zhang, Oscar Hernández Mondragón, Mathieu Pioche, Steven Steinway, Jose Nieto, et al.. Zenker’s peroral endoscopic myotomy for management of large Zenker’s diverticulum. Endoscopy, 2023, 55 (06), pp.501-507. ⟨10.1055/a-2025-0715⟩. ⟨hal-04601561⟩
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