Zenker per-oral endoscopic myotomy (Z-POEM): The ideal first-line therapy for treatment of Zenker diverticulum

作者：Vaibhav Gupta, Stephen Gowing, Ahmad Khoja, S M Mahmudul Hasan, Sean Higgins, Richard Liu, Biniam Kidane · 发表于：Journal of Thoracic and Cardiovascular Surgery · 年份：2024 · DOI：10.1016/j.jtcvs.2024.11.033 · 被引用次数：9 · 研究领域：Dysphagia Assessment and Management、Gastroesophageal reflux and treatments、Esophageal and GI Pathology

OBJECTIVE: Zenker diverticulum is a mucosal herniation at the pharyngoesophageal junction. Although open surgical myotomy is the conventional treatment, robust evidence on third-space flexible endoscopic myotomy is lacking. We assessed safety, effectiveness, and patient-reported outcomes of per-oral endoscopic myotomy (Z-POEM) in the largest reported single-center experience with this technique. METHODS: A retrospective cohort study was performed of consecutive patients undergoing Z-POEM in a tertiary hospital thoracic surgery practice from 2018 to 2024. Data collected included demographics, comorbidities, clinical and radiographic (pre/postoperative esophagram) outcomes, and validated patient-reported quality-of-life outcomes (Dakkak and Eckardt scores). Descriptive analyses were used to describe the population, outcomes, and complications. Aggregate and individual-patient symptom trajectories were charted over time. RESULTS: Fifty-seven patients (57.9% female, n = 33) with a mean age of 74 years underwent Z-POEM. Median diverticulum size was 2 cm (interquartile range, 2-3). All patients reported subjective symptom improvement and showed complete resolution of obstructed barium flow on postoperative esophagrams. At median follow-up of 9 months, all patients who underwent Z-POEM reported clinically important improvements in objective symptom scores, with symptom trajectories showing rapid and durable improvement up to 5 years postoperatively. Four patients (7%) experienced co...