Flexible endoscopic treatment for Zenker’s diverticulum: from the lumen to the third space

Maselli, Roberta; Spadaccini, Marco; Cappello, Annalisa; Leo, Milena Di; Fugazza, Alessandro; Pellegatta, Gaia; Galtieri, Piera Alessia; Ferrara, E.C.; Anderloni, Andrea; Carrara, Sandro; Chandrasekar, Viveksandeep Thoguluva; Belletrutti, Paul J.; Repici, Alessandro

doi:10.20524/aog.2021.0575

Cited by 13 publications

(16 citation statements)

References 37 publications

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“…Different cutting devices are available and used by endoscopists depending on their training and experience, such as needle knife, hook knife, monopolar forceps, argon plasma coagulation 37. The most frequently used device is the hook knife and the needle knife (Olympus Medical, Tokyo, Japan) 37. While variations exist among endoscopic technique, there are no randomized control trials.…”

Section: Discussionmentioning

confidence: 99%

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Peroral Endoscopic Myotomy for the Treatment of Esophageal Diverticula

Facciorusso

Ramai

Ichkhanian

et al. 2021

Journal of Clinical Gastroenterology

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Background: There is limited evidence on the efficacy of peroral endoscopic myotomy (POEM) in patients with esophageal diverticula.Aims: This meta-analysis aimed to assess the efficacy and safety profile of POEM in patients with Zenker (ZD) and epiphrenic diverticula.Methods: With a literature search through August 2020, we identified 12 studies (300 patients) assessing POEM in patients with esophageal diverticula. The primary outcome was treatment success. Results were expressed as pooled rates and 95% confidence intervals.Results: Pooled rate of technical success was 95.9% (93.4%-98.3%) in ZD patients and 95.1% (88.8%-100%) in patients with epiphrenic diverticula. Pooled rate of treatment success was similar for ZD (90.6%, 87.1%-94.1%) and epiphrenic diverticula (94.2%, 87.3%-100%). Rates of treatment success were maintained at 1 year (90%, 86.4%-97.4%) and 2 years (89.6%, 82.2%-96.9%) in ZD patients. Pooled rate of symptom recurrence was 2.6% (0.9%-4.4%) in ZD patients and 0% in patients with epiphrenic diverticula. Pooled rates of adverse events and severe adverse events were 10.6% (4.6%-16.6%) and 3.5% (0%-7.4%) in ZD and 8.4% (0%-16.8%) and 8.4% (0%-16.8%) in epiphrenic diverticula, respectively. Conclusion:POEM represents an effective and safe therapy for the treatment of esophageal diverticula.

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Section: Discussionmentioning

confidence: 99%

“…37 The most frequently used device is the hook knife and the needle knife (Olympus Medical, Tokyo, Japan). 37 While variations exist among endoscopic technique, there are no randomized control trials.…”

Section: Discussionmentioning

confidence: 99%

Peroral Endoscopic Myotomy for the Treatment of Esophageal Diverticula

Facciorusso

Ramai

Ichkhanian

et al. 2021

Journal of Clinical Gastroenterology

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“… 3 Recently, submucosal tunneling technique (Z‐POEM) was adopted as it has an advantage to completely dissect the septum while maintaining mucosal integrity. 6 , 7 Although it has not been proven to be superior to conventional methods, the recent literature shows Z‐POEM is a safe and feasible treatment option with technical success rate of 95% and adverse event rate of 6% comparable with conventional technique. 5 Endoscopic approach has not been widely applied for KJD as it is technically challenging to create the submucosal tunnel proximal to the septum and to securely close the mucosal defect especially in case with KJD due to limited working space.…”

Section: Discussionmentioning

confidence: 99%

“…Transcervical surgical myotomy is considered the mainstay approach for the management; however, endoscopic therapies have been reported as safe and effective 3 . Recently, submucosal tunneling technique (Z‐POEM) was adopted as it has an advantage to completely dissect the septum while maintaining mucosal integrity 6,7 . Although it has not been proven to be superior to conventional methods, the recent literature shows Z‐POEM is a safe and feasible treatment option with technical success rate of 95% and adverse event rate of 6% comparable with conventional technique 5 .…”

Section: Discussionmentioning

confidence: 99%

Per‐oral endoscopic myotomy as treatment for Killian–Jamieson diverticulum

et al. 2021

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Killian–Jamieson diverticulum (KJD) is a rare type of esophageal diverticulum less commonly encountered compared with Zenker's diverticulum (ZD). Endoscopic approach for these diverticula has been rapidly evolving. Currently, a flexible endoscopic septum division is considered the first‐line treatment for symptomatic ZD patients, however reported recurrence rates are over 10% according to recent literature. With the advent of submucosal tunneling technique established by per‐oral endoscopic myotomy for achalasia, it has been applied to treat ZD named as Zenker's diverticulum per‐oral endoscopic myotomy (Z‐POEM) as a minimally invasive treatment. Although there are very few reports utilizing submucosal tunneling approach to KJD, we have opted to perform Z‐POEM in order to safely perform complete dissection of the muscle septum while maintaining mucosal integration. Due to the difficulty of anatomical location of KJD, we created mucosal incision and subsequent submucosal tunnel directly at the level of the septum as opposed to creating a submucosal tunnel few centimeters proximal to the septum as being previously proposed. We report a case in which this technique was successfully performed with complete resolution of dysphagia without any adverse event. This technique permits to perform complete myotomies without the fear of causing perforation. Although larger cohorts are required to assess its safety and efficacy, Z‐POEM to treat KJD seems to be promising.

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“…Zenker’s diverticulum (ZD), the most common hypopharyngeal diverticulum, is a sac-like outpouching of the mucosa and submucosa through an area of muscular weakness between the transverse fibers of the cricopharyngeal muscle and the oblique fibers of the lower inferior constrictor muscle [ 69 ]. Patients with symptomatic ZD most commonly present with dysphagia and regurgitation, with complications including weight loss and aspiration pneumonia.…”

Section: Zenker’s Per-oral Endoscopic Myotomy (Z-poem)mentioning

confidence: 99%

Third-space endoscopy: the final frontier

Hayat

Yang

Draganov

2022

Gastroenterology Report

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Over the years, our growing experience with endoscopic submucosal dissection along with technological advances has solidified our comfort and knowledge on working in the submucosa, also referred to as the “third space.” Per-oral endoscopic myotomy (POEM) was the first prototype third-space endoscopy (TSE) procedure, demonstrating the feasibility and clinical utility of endoscopic esophagogastric myotomy via submucosal tunneling. The launch of POEM accelerated the evolution of TSE from a vanguard concept to an expanding field with a wide range of clinical applications. In this review, we discuss the status and future directions of multiple TSE interventions.

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Flexible endoscopic treatment for Zenker’s diverticulum: from the lumen to the third space

Cited by 13 publications

References 37 publications

Peroral Endoscopic Myotomy for the Treatment of Esophageal Diverticula

Peroral Endoscopic Myotomy for the Treatment of Esophageal Diverticula

Per‐oral endoscopic myotomy as treatment for Killian–Jamieson diverticulum

Third-space endoscopy: the final frontier

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