An international study on the use of peroral endoscopic myotomy (POEM) in the management of esophageal diverticula: the first multicenter D-POEM experience

Endoscopy. 2019 Apr;51(4):346-349. doi: 10.1055/a-0759-1428. Epub 2018 Nov 19.

Abstract

Background: The aim of this study is to report a novel, multicenter experience with the diverticular peroral endoscopic myotomy (D-POEM) technique in the management of esophageal diverticula.

Methods: This is a multicenter, international, retrospective study involving three centers. D-POEM was performed using the principles of submucosal endoscopy.

Results: A total of 11 patients with an esophageal diverticulum (Zenker's 7, mid-esophagus 1, epiphrenic 3) were included. The mean size of the esophageal diverticula was 34.5 mm. The overall technical success rate of D-POEM was 90.9 %, with a mean procedure time of 63.2 minutes. There were no adverse events. Clinical success was achieved in 100 % (10 /10), with a decrease in mean dysphagia score from 2.7 to 0.1 (P < 0.001) during a median follow-up of 145 days (interquartile range 126 - 273).

Conclusion: Endoscopic management of esophageal diverticula using the novel technique of D-POEM appears promising. This first case series on D-POEM suggests that the procedure is feasible, safe, and effective in the management of esophageal diverticula. D-POEM offers the distinct advantage of ensuring a complete septotomy. Larger studies are needed to confirm these intriguing results.

Publication types

  • Multicenter Study

MeSH terms

  • Diverticulum, Esophageal* / classification
  • Diverticulum, Esophageal* / diagnosis
  • Diverticulum, Esophageal* / surgery
  • Esophagoscopy* / adverse effects
  • Esophagoscopy* / methods
  • Female
  • Humans
  • Male
  • Manometry / methods
  • Middle Aged
  • Myotomy* / adverse effects
  • Myotomy* / methods
  • Natural Orifice Endoscopic Surgery / adverse effects
  • Natural Orifice Endoscopic Surgery / methods
  • Outcome and Process Assessment, Health Care
  • Retrospective Studies
  • Treatment Outcome