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CC BY 4.0 · Endosc Int Open 2023; 11(05): E546-E552
DOI: 10.1055/a-2071-6744
Original article

Efficacy and safety of peroral endoscopic myotomy for esophageal diverticula

Elise M. Wessels 
1   Amsterdam University Medical Centres, Gastroenterology & Hepatology, Amsterdam, Netherlands
,
Jeroen M. Schuitenmaker
1   Amsterdam University Medical Centres, Gastroenterology & Hepatology, Amsterdam, Netherlands
,
Barbara A.J. Bastiaansen
1   Amsterdam University Medical Centres, Gastroenterology & Hepatology, Amsterdam, Netherlands
,
Paul Fockens
1   Amsterdam University Medical Centres, Gastroenterology & Hepatology, Amsterdam, Netherlands
,
Gwen M.C. Masclee
1   Amsterdam University Medical Centres, Gastroenterology & Hepatology, Amsterdam, Netherlands
,
Albert J. Bredenoord
2   Amsterdam University Medical Centres, Gastroenterology & Hepatology, Duivendrecht, Netherlands
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Abstract

Background and study aims Epiphrenic diverticula are rare and mainly occur in patients with underlying esophageal motility disorders. The current standard treatment is surgical diverticulectomy often combined by myotomy and is associated with significant adverse event (AE) rates. The aim of this study was to examine the efficacy and safety of peroral endoscopic myotomy in reducing esophageal symptoms in patients with esophageal diverticula.

Patients and methods We performed a retrospective cohort study including patients with an esophageal diverticulum who underwent POEM between October 2014 and December 2022. After informed consent, data were extracted from medical records and patients completed a survey by telephone. The primary outcome was treatment success, defined as Eckardt score below 4 with a minimal reduction of 2 points.

Results Seventeen patients (mean age 71 years, 41.2 % female) were included. Achalasia was confirmed in 13 patients (13 /17, 76.5 %), Jackhammer esophagus in two patients (2 /17, 11.8 %), diffuse esophageal spasm in one patient (1 /17, 5.9 %) and in one patient no esophageal motility disorder was found (1 /17, 5.9 %). Treatment success was 68.8 % and only one patient (6.3 %) underwent retreatment (pneumatic dilatation). Median Eckardt scores decreased from 7 to 1 after POEM (p < 0.001). Mean size of the diverticula decreased from 3.6 cm to 2.9 cm after POEM (p < 0.001). Clinical admission was one night for all patients. AEs occurred in two patients (11.8 %) which were classified as grade II and IIIa (AGREE classification).

Conclusions POEM is effective and safe to treat patients with esophageal diverticula and an underlying esophageal motility disorder.

Supplementary material



Publication History

Received: 21 February 2023

Accepted after revision: 03 April 2023

Accepted Manuscript online:
11 April 2023

Article published online:
26 May 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

Comment to this article:

Endoscopy International Open – recently publishedEndoscopy 2023; 55(08): 782-782
DOI: 10.1055/a-2099-9196

 

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