Singh Sahib, Chandan Saurabh, Bapaye Jay, Brar Himmat S, Mohammed Abdul, Kassab Lena L, Bhat Ishfaq, Singh Shailender, Bapaye Amol, Yang Dennis
Department of Internal Medicine, Sinai Hospital, Baltimore, MD, USA (Sahib Singh).
Center for Interventional Endoscopy (CIE), Advent Health, Orlando, FL, USA (Saurabh Chandan, Dennis Yang).
Ann Gastroenterol. 2025 Jan-Feb;38(1):20-27. doi: 10.20524/aog.2024.0934. Epub 2024 Dec 12.
Endoscopic treatments of symptomatic Zenker's diverticulum (ZD) include flexible endoscopic septotomy (FES) and, more recently, peroral endoscopic myotomy (Z-POEM). Data comparing these techniques are limited. We conducted a meta-analysis evaluating FES vs. Z-POEM for symptomatic ZD.
Multiple databases were searched from inception to September 2024. Our primary outcomes were clinical and technical success. Secondary outcomes included adverse events, length of hospital stay (LOS), procedure time, and recurrence. A random-effects model was used, and outcomes were represented as pooled rates, relative risk (RR) and standardized mean difference (SMD), along with 95% confidence intervals (CI).
Seven studies with 580 patients (Z-POEM=274, FES=306) were included. Mean age ranged from 68.9-74.9 years. The diverticulum size was not statistically different between the 2 groups: SMD -3.78 (-11.68 to 4.12), P=0.35. The pooled technical success was similar for Z-POEM and FES: RR 0.99 (95%CI 0.96-1.02; =0%); P=0.4. Clinical success rate was significantly higher for Z-POEM compared to FES: RR 1.11 (95%CI 1.04-1.18; =16%); P=0.001. There were no statistically significant differences between the 2 treatment modalities in pooled rate of recurrence, adverse events, LOS or procedural time.
Our analysis shows that Z-POEM and FES in the treatment of symptomatic ZD are both associated with high technical success and a good safety profile, and have comparable procedural times and rates of recurrence. Z-POEM may offer higher rates of clinical success at follow up.
有症状的Zenker憩室（ZD）的内镜治疗包括柔性内镜隔膜切开术（FES），以及最近的经口内镜肌切开术（Z-POEM）。比较这些技术的数据有限。我们进行了一项荟萃分析，评估FES与Z-POEM治疗有症状ZD的效果。
检索了从开始到2024年9月的多个数据库。我们的主要结局是临床和技术成功率。次要结局包括不良事件、住院时间（LOS）、手术时间和复发情况。采用随机效应模型，结局以合并率、相对风险（RR）和标准化均差（SMD）以及95%置信区间（CI）表示。
纳入了7项研究，共580例患者（Z-POEM组274例，FES组306例）。平均年龄在68.9至74.9岁之间。两组间憩室大小无统计学差异：SMD为-3.78（-11.68至4.12），P = 0.35。Z-POEM和FES的合并技术成功率相似：RR为0.99（95%CI为0.96至1.02；I² = 0%）；P = 0.4。与FES相比，Z-POEM的临床成功率显著更高：RR为1.11（95%CI为1.04至1.18；I² = 16%）；P = 0.001。两种治疗方式在复发率、不良事件、住院时间或手术时间的合并率方面无统计学显著差异。
我们的分析表明，Z-POEM和FES治疗有症状ZD均具有较高的技术成功率和良好的安全性，手术时间和复发率相当。Z-POEM在随访时可能具有更高的临床成功率。
