Peroral endoscopic myotomy, septotomy, and restoration of esophageal lumen with over-the-scope clips: closing the circle of esophageal diverticula management

Arbizu, Eduardo Albéniz; Estremera-Arévalo, Fermín; Alonso, Marta Gómez; Rosón, Pedro; Rojo, Francisco Javier Gallego; Vila, Juan J.; Montori, Sheyla

doi:10.1055/a-1724-6801

Cited by 3 publications

(2 citation statements)

References 4 publications

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“…A subset of patients may not improve clinically because the diverticular pouch remains intact. To overcome this problem, some authors have proposed the pouch endoscopic resection and suturing (27) or eversion of the diverticular lumen with OTSC (28).…”

Section: D-poemmentioning

confidence: 99%

POEM from A to Z: current perspectives

Albéniz¹,

Valenciano²,

Estremera-Arévalo³

et al. 2023

Rev Esp Enferm Dig

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Section: D-poemmentioning

confidence: 99%

POEM from A to Z: current perspectives

Albéniz¹,

Valenciano²,

Estremera-Arévalo³

et al. 2023

Rev Esp Enferm Dig

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“…Given the fact that esophageal motility disorders are mainly the underlying cause of epiphrenic diverticula, the idea is to treat primarily the underlying cause by myotomy without diverticulotomy in order to reduce symptoms as well as the chance of developing new diverticula. In case of persistent symptoms after POEM, a second intervention can be considered for additional diverticulotomy, diverticulectomy or resection of the diverticular pouch [8,[14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of peroral endoscopic myotomy for esophageal diverticula

et al. 2023

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Background Epiphrenic diverticula are rare and mainly occur in patients with underlying esophageal motility disorders. The current standard treatment is surgical diverticulectomy often combined with myotomy and is associated with significant adverse event rates. The aim of this study is to examine the efficacy and safety of peroral endoscopic myotomy in reducing esophageal symptoms in patients with esophageal diverticula. Methods We performed a retrospective cohort study including patients with an esophageal diverticulum who underwent POEM between October 2014 and December 2022. After informed consent, data was extracted from medical records and patients completed a survey by telephone. Primary outcome was treatment success, defined as Eckardt score below four with a minimal reduction of two points. Results Seventeen patients (mean age 71 years, 41.2% female) were included. Achalasia was confirmed in 13 patients (13/17, 76.5%), Jackhammer esophagus in two patients (2/17, 11.8%), diffuse esophageal spasm in one patient (1/17, 5.9%) and in one patient no esophageal motility disorder was found (1/17, 5.9%). Treatment success was 68.8% and only one patient (6.3%) underwent retreatment (pneumatic dilatation). Median Eckardt scores decreased from seven to one after POEM (p < 0.001). Mean size of the diverticula decreased from 3.6 cm to 2.9 cm after POEM (p < 0.001). Clinical admission was one night for all patients. Adverse events occurred in two patients (11.8%) which were classified as grade II and IIIa (AGREE classification). Conclusion POEM is effective and safe to treat patients with esophageal diverticula and an underlying esophageal motility disorder.

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