Zenker's peroral endoscopic myotomy, or flexible or rigid septotomy for Zenker's diverticulum: a multicenter retrospective comparison.
Journal
Endoscopy
ISSN: 1438-8812
Titre abrégé: Endoscopy
Pays: Germany
ID NLM: 0215166
Informations de publication
Date de publication:
04 2022
04 2022
Historique:
pubmed:
2
7
2021
medline:
3
5
2022
entrez:
1
7
2021
Statut:
ppublish
Résumé
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. 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. 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 ( 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.
Sections du résumé
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 (
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.
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
345-351Commentaires et corrections
Type : CommentIn
Informations de copyright
Thieme. All rights reserved.
Déclaration de conflit d'intérêts
M.A. Khashab is a consultant for Boston Scientific, Olympus, Medtronic, 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 Lifesciences, 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.