Endoscopy 2019; 51(04): S123-S124
DOI: 10.1055/s-0039-1681534
ESGE Days 2019 oral presentations
Saturday, April 6, 2019 14:30 – 16:00: Motility 2 Panorama Hall
Georg Thieme Verlag KG Stuttgart · New York

SUBMUCOSAL TUNNELLING ENDOSCOPIC SEPTUM DIVISION (Z-POEM) FOR ZENKER'S DIVERTICULUM: A NEW EMERGING TECHNIQUE COMPARED TO CONVENTIONAL ENDOSCOPIC SEPTOTOMY

P Desai
1   Endoscopy, Surat Institute of Digestive Sciences, Surat, India
,
M Kabrawala
1   Endoscopy, Surat Institute of Digestive Sciences, Surat, India
,
S Nandwani
2   Surat Institute of Digestive Sciences, Surat, India
,
R Mehta
2   Surat Institute of Digestive Sciences, Surat, India
,
C Patel
1   Endoscopy, Surat Institute of Digestive Sciences, Surat, India
,
P Kalra
2   Surat Institute of Digestive Sciences, Surat, India
,
R Prajapati
1   Endoscopy, Surat Institute of Digestive Sciences, Surat, India
,
N Patel
2   Surat Institute of Digestive Sciences, Surat, India
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

Zenker's diverticulum (ZD) is an acquired protrusion of the esophageal wall. A wide variety of different treatment techniques have been published. Historically ZD managed by surgery and for last few years endoscopic septum division is done. We compared the clinical success of Z-POEMfor ZD with conventional.

Methods:

Patient treated with conventional septotomy from 2013 to 2016 and with Z-POEM from 2016 – 2018 for ZD, were included in our retrospective data analysis. A total 15 patients (9 men), who were presented symptomatic ZD were treated with conventional septotomy (n = 8) and Z-POEM (n = 7). A mean age was 71.4 years (range 67 – 81). The most common symptom was dysphagia (78.6%), which was recorded by a 0 – 4 score (0 = no dysphagia, 1 = solids, 2 = semisolids, 3 = liquids, 4 = saliva).

Results:

Clinical response was significantly more frequent in the Z-POEM (50.0% vs. 0%; P =0.05). Z-POEM patients had shorter mean hospital stay than conventional septotomy patients (1.1day vs. 2.5day; P< 0.05) despite longer procedure time of Z-POEM (49 min vs. 34.5 min; P< 0.05). Conventional septotomy shown significantly longer mean remaining length of septum than Z-POEM (5.5 mm vs. 2.6 mm; P =0.05). The complete resolution of sole complaint regurgitation by Z-POEM (100% vs. 37%; P =0.05). Patients were followed for at least 18 months and showed a favourable outcome; more recurrence of symptoms in conventional 3/8 v/s 0/7 in Z POEM (37.5% vs. 0%; P< 0.05). Rate of adverse events significantly less in the Z-POEM group (14.3% vs. 62.5%; P< 0.05). There were no cases of bleeding in Z-POEM and in conventional septotomy two cases (25%) bleeding who required endoscopic intervention.

Conclusions:

POEM allows for a longer myotomy than conventional septotomy, which may result in improved clinical outcomes. Z-POEM appears to be an effective and safe alternative to conventional septotomy in patients with ZD.