Peroral endoscopic septotomy for short-septum Zenker's diverticulum

Alessandro Repici, Marco Spadaccini, Paul James Belletrutti, Piera Alessia Galtieri, Alessandro Fugazza, Andrea Anderloni, Silvia Carrara, Milena Di Leo, Gaia Pellegatta, Annalisa Cappello, Carlo Castoro, Yervant Ichkhanian, Mouen A. Khashab, Roberta Maselli

Research output: Contribution to journalArticlepeer-review

Abstract

Background  Treatments of Zenker's diverticulum aim to dissect the cricopharyngeal muscle, removing the underlying source of dysfunction. This is difficult in patients with a short-septum (≤ 20 mm) diverticulum because the limited anatomical space restricts the operating area for either rigid or flexible endoscopic approaches. The aim of this study was to investigate the efficacy and safety of a novel third-space approach, peroral endoscopic septotomy (POES), for treating symptomatic patients with short-septum Zenker's diverticulum. Methods  All patients with short-septum Zenker's diverticulum who were referred for endoscopic repair from September 2017, were considered for the study. Outcomes included procedure-related adverse events and symptom improvement. The Dakkak - Bennett score was used to quantify dysphagia. Results  20 patients (men 12, women 8; mean age 67.9 years [SD 14.3]) underwent POES. All procedures were performed with patients under deep sedation. Mean size of Zenker's diverticulum was 17.5 mm (SD 3.0) and mean dysphagia score was 2.7 (SD 0.5). Average procedure time was 13.8 minutes (SD 5.1). No intra- or post- procedural adverse events occurred. Septal myotomy was successfully completed in all patients. Dysphagia significantly improved in 19 out of 20 patients. Dakkak - Bennett score improved to 0.3 (SD 0.5), P  < 0.0001). No recurrences were reported in a mean follow-up time of 12.0 months (SD 3.7, range 6 - 20). Conclusions  POES may be considered as a potential alternative for the treatment of short-septum Zenker's diverticulum. Further data are required to validate this technique and compare it with already available rigid and flexible approaches.

Original languageEnglish (US)
Pages (from-to)563-568
Number of pages6
JournalEndoscopy
Volume52
Issue number7
DOIs
StatePublished - Jul 1 2020

ASJC Scopus subject areas

  • Gastroenterology

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