ArticleSurgical endoscopy2025
Long-term outcomes of Zenker's peroral endoscopic myotomy: endoscopic suturing is effective for large Zenker's diverticula.
Article in Surgical endoscopy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPeroral Endoscopic Myotomy has been adapted for the treatment of Zenker's diverticula (ZD). Endoscopic suturing for ZD has shown early promise as an alternative treatment modality for large ZD. Currently, there are no long-term studies that aim to compare long-term outcomes of patients undergoing Z-POEM and endoscopic suturing for large ZD. This study was undertaken to determine the long-term outcomes of patients undergoing Z-POEM and Z-POEM with endoscopic suturing at a single institution.
methodsA retrospective review of a prospectively maintained gastroesophageal database was performed for all patients undergoing Z-POEM with standard closure of the mucosal defect with clips and Z-POEM with endoscopic suturing at a single institution. Demographic data, outcomes, and quality of life scores were analyzed and compared between groups with the Kruskal-Wallis test.
resultsFrom 2014 to 2024, 75 patients underwent endoscopic treatment for ZD. Z-POEM for ZD ≤ 4 cm (N = 62), Z-POEM for ZD > 4 cm (N = 9), and Z-POEM with endoscopic suturing for ZD > 4 cm (N = 4). The overall technical and clinical success rates were 100% and 89.5%, respectively. A higher proportion of patients undergoing Z-POEM for ZD > 4 cm had more post-operative interventions compared to those undergoing Z-POEM for ZD ≤ 4 cm (p = 0.002). Interventions included endoscopic suturing, redo Z-POEM, and endoscopic fistula closure. No patients with ZD > 4 cm who underwent Z-POEM with endoscopic suturing required post-operative interventions. No patients who underwent endoscopic suturing for large ZD had any complications or required any postoperative interventions. The Z-POEM > 4 cm group had worse Dysphagia scores 6 months postoperatively.
conclusionPatients with ZD > 4 cm who undergo Z-POEM with clip closure are more likely to undergo postoperative interventions due to persistent symptoms. Z-POEM with endoscopic suturing provides a safe and effective alternative treatment option for such patients.
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