Johns Hopkins Medicine, Baltimore, Maryland, United States.
National Medical Center Century XXI, Mexico City, Mexico.
Endoscopy. 2023 Jun;55(6):501-507. doi: 10.1055/a-2025-0715. Epub 2023 Feb 24.
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.
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.
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]; < 0.001), regurgitation (3 2 3 4 vs. 0 [0-0]; < 0.001), and respiratory symptoms (2 [0-3] vs. 0 [0-0]; < 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 %).
This study demonstrated safe and effective use of zPOEM in the management of large Zenker's diverticulum.
Zenker 憩室经口内镜肌切开术（zPOEM）是一种治疗 Zenker 憩室的微创治疗策略，对于管理小至中等大小的 Zenker 憩室效果极佳。我们评估了其在治疗大型 Zenker 憩室中的应用。
这是一项回顾性多中心队列研究，涉及 11 个国际中心的成年患者，这些患者在 2017 年 3 月至 2022 年 3 月期间接受了 zPOEM 治疗，Zenker 憩室≥40mm。主要结果是临床成功（吞咽困难评分≤1 且无需进一步干预）。次要结果包括技术成功（预期完成肌切开术）、不良事件（AE）和复发率。
83 例（男性 62.7%，平均年龄 72.6[11.5]岁）接受 zPOEM 治疗大型 Zenker 憩室（中位数大小 50mm，四分位距[IQR]41-55mm，范围 40-80mm）。82 例（98.8%）患者的 zPOEM 手术技术成功，平均手术时间为 48.7（23.2）分钟。71 例（85.5%）患者达到临床成功。吞咽困难（223 与 0[0-2]；<0.001）、反流（3234 与 0[0-0]；<0.001）和呼吸症状（2[0-3]与 0[0-0]；<0.001）的症状评分均从基线显著改善。在达到临床成功的患者中，中位随访 12.2 个月（IQR 3-28）期间仅记录到 1 例（1.4%）复发。4 例（4.8%）患者发生术后轻度至中度 AE。
本研究表明 zPOEM 在治疗大型 Zenker 憩室方面安全有效。
