Modified Per-Oral Endoscopic Septo-Miotomy (m-POESM) for Zenker Diverticulum management: results from a prospective cohort at a tertiary referral center

Aims Endoscopy is the first-line approach for Zenker Diverticulum (ZD) management. Various endoscopic techniques have been described, each with its advantages and limitations. We present a new technique called Modified Per-Oral Endoscopic Septo-Miotomy (m-POESM) and describe the results from our initial experience in a prospective cohort.

Methods We prospectively followed up all consecutive patients who underwent m-POESM from June 2019 to August 2023. The procedures were performed using a slim gastroscope (diameter 9 mm, operative channel 2.8 mm) equipped with a tapered cap on patients under general anesthesia. The m-POESM procedure involves a direct incision of the septum with a Hook Knife and a cricopharyngeal myotomy. The progressive tunneling within the muscle is facilitated by the submucosal infiltration, which allows for the enhanced distinction of the muscle fibers. Clinical success (CS) was defined as a Dakkak Bennet Dysphagia Score (DBDS) of<=1 at 3 months. Adverse Events (AEs) are classified according to AGREE Classification.

Results Eight patients (50% male) with median age of 71 (IQR 67-77) and Body Mass Index of 25 (IQR 27-24) were enrolled, most of them classified as ASA 1 (5/8, 62.5%). The median depth of the diverticula was 30 mm (IQR 27-45). Median procedural time was 30 minutes (IQR 23-46) and the median hospital stay was 2 days (IQR 2-1). Technical success was achieved in all cases. We documented an intraprocedural perforation, which was successfully treated by covered self-expandable metal stent placement (AGREE IIIa), resulting in no clinical sequalae. Clinical success was achieved in all patients (100%). After a median follow-up of 239 days (IQR 98-529), no cases of symptom recurrence were recorded.

Conclusions m-POESM is a simple and effective technique with a favorable safety rate for ZD management, and it enables the simultaneous achievement of a complete myotomy and a reduction of the residual mucosal flap. Further validation of the technique is required through larger cohort studies.

Publication History

Article published online:
15 April 2024