Treatment of Zenker's diverticulum using ZPOEM: short-term and long-term results.

Abstract

Introduction: Zenker's diverticulum (ZD) is a condition with a low incidence, typically asymptomatic, and when symptoms are present, the most common are food regurgitation and dysphagia. Therapeutic strategies include surgical and endoscopic techniques. Endoscopic techniques are usually preferred, with flexible endoscopic septotomy (FESD) being the most common. Peroral endoscopic myotomy (Z-POEM) offers advantages over previous techniques by providing a more controlled and complete myotomy, reducing the risk of complications and recurrence rates.

Material and methods: This is a unicentric retrospective study including patients treated with Z-POEM between January 2022 and July 2024, with a mean follow-up of 1 year. Baseline clinical variables, treatment response, techniques, and safety were analyzed.

Results: A total of 8 patients were included, with a mean age of 69.35 ± 10.11 years. The average diverticulum size was 3.62 ± 1.4 cm. The technical success rate was 100%, the clinical success rate was 87.5% at 3 months, and 42.86% at 12 months. Three patients required reintervention endoscopically. One case of intraprocedural bleeding was recorded, which was resolved endoscopically, and one patient experienced self-limited dysphonia.

Conclusions: Z-POEM may be an effective and safe therapeutic option for the treatment of ZD.

In the case of endoscopic reintervention, another Z-POEM or an alternative technique (FESD) can be considered.

Keywords: Zenker's diverticulum, Z-POEM, miotomy, endoscopy.