Norton Benjamin, Siggens Katie, Papaefthymiou Apostolis, Telese Andrea, Duku Margaret, Murino Alberto, Johnson Gavin, Murray Charles, Mohammadi Borzoueh, Mughal Muntzer, Bisschops Raf, Mohammed Noor, Bhandari Pradeep, Birchall Martin, Haidry Rehan
Digestive Diseases and Surgical Institute, Cleveland Clinic London, London, UK.
Department of Gastroenterology, University College London Hospital, London, UK.
Dig Dis. 2025 Jun 30:1-11. doi: 10.1159/000546645.
A Zenker diverticulum (ZD) is a sac-like outpouching at the pharyngo-oesophageal junction, which is characterised by dysphagia and regurgitation. Surgery has been the predominant treatment but carries the burden of invasiveness, complications, and recurrence. Zenker peroral endoscopic myotomy (Z-POEM) is an alternative minimally invasive endoscopic treatment for ZD. We report on the safety and efficacy of Z-POEM in the UK.
Consecutive patients undergoing Z-POEM by expert interventional endoscopists at four UK referral centres were retrospectively analysed between 2019 and 2024. Patient demographics, technical and clinical success, and 30-day adverse events were recorded. The primary outcome was clinical success, which was defined as a reduction in Dakkak and Bennett dysphagia score to ≤1 without need for repeat intervention.
Among 61 patients undergoing Z-POEM, the median age was 76 (IQR 69-80), 37.7% (n = 23) were female, mean pouch size was 37.3 mm (SD 18.0) in depth, and 37.3% had undergone prior intervention. The overall technical success was 100%, mean procedural time was 49.4 min (SD 19.3), and 10 patients underwent a hybrid procedure due to submucosal fibrosis. Overall, the clinical success was 93.1% over a mean follow-up of 11.2 months. There were five AEs related to the procedure classified as AGREE grade II (8.5%), and the recurrence rate was 11.1% over a median time of 7.5 months (IQR 6.3-10.3).
Z-POEM is a safe and effective endoscopic treatment for ZD that is associated with high technical and clinical success. A hybrid procedure may be utilised in the presence of submucosal fibrosis.
Zenker憩室（ZD）是咽食管交界处的囊状突出，其特征为吞咽困难和反流。手术一直是主要治疗方法，但存在侵入性、并发症和复发等问题。Zenker经口内镜肌切开术（Z-POEM）是ZD的一种替代性微创内镜治疗方法。我们报告Z-POEM在英国的安全性和有效性。
回顾性分析2019年至2024年期间在英国四个转诊中心由专家介入内镜医师进行Z-POEM的连续患者。记录患者人口统计学、技术和临床成功率以及30天不良事件。主要结局为临床成功，定义为Dakkak和Bennett吞咽困难评分降至≤1且无需重复干预。
在61例接受Z-POEM的患者中，中位年龄为76岁（四分位间距69 - 80岁），37.7%（n = 23）为女性，平均憩室深度为37.3 mm（标准差18.0），37.3%曾接受过先前干预。总体技术成功率为100%，平均手术时间为49.4分钟（标准差19.3），10例患者因黏膜下纤维化接受了混合手术。总体而言，在平均11.2个月的随访中临床成功率为93.1%。有5例与手术相关的不良事件被分类为AGREE II级（8.5%），在中位时间7.5个月（四分位间距6.3 - 10.3）内复发率为11.1%。
Z-POEM是一种安全有效的ZD内镜治疗方法，技术和临床成功率高。在存在黏膜下纤维化的情况下可采用混合手术。
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