Endoscopy 2021; 53(04): 346-353
DOI: 10.1055/a-1219-4516
Original article

Practice patterns, techniques, and outcomes of flexible endoscopic myotomy for Zenker’s diverticulum: a retrospective multicenter study

Chetan Mittal
1  Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
,
David L. Diehl
2  Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, United States
,
Peter V. Draganov
3  Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, United States
,
Laith H. Jamil
4  Division of Gastroenterology and Hepatology, William Beaumont hospital, Royal Oak, Michigan, United States
,
Ammara Khalid
2  Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, United States
,
Harshit S. Khara
2  Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, United States
,
Vikas Khullar
3  Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, United States
,
Ryan Law
5  Division of Gastroenterology and Hepatology, The University of Michigan, Ann Arbor, Michigan, United States
,
Simon K. Lo
6  Division of Digestive and Liver Disease, Cedars-Sinai Medical Center, Los Angeles, California, United States
,
Abraham Mathew
7  Division of Gastroenterology and Hepatology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
,
Ebrahim Mirakhor
6  Division of Digestive and Liver Disease, Cedars-Sinai Medical Center, Los Angeles, California, United States
,
Alireza Sedarat
8  Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
,
Neil Sharma
9  Parkview Health System and Cancer Institute, Fort Wayne, Indiana, United States
,
Setareh Sharzehi
7  Division of Gastroenterology and Hepatology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
,
Anna Tavakkoli
10  University of Texas Southwestern Medical Center, Dallas, Texas, United States
,
Adarsh Thaker
8  Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
,
Nirav Thosani
11  Division of Gastroenterology, Hepatology and Nutrition, McGovern Medical School, UTHealth, Houston, Texas, United States
,
Dennis Yang
3  Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, United States
,
Christina Zelt
9  Parkview Health System and Cancer Institute, Fort Wayne, Indiana, United States
,
Mihir S. Wagh
1  Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
› Institutsangaben

Abstract

Background Flexible endoscopic myotomy has been increasingly performed for Zenker’s diverticulum using various endoscopic techniques and devices. The main aims of this study were to assess practice patterns and compare outcomes of endoscopic myotomy for Zenker’s diverticulum.

Methods Procedures performed at 12 tertiary endoscopy centers from 1/2012 to 12/2018 were reviewed. Patients (≥ 18 years) with Zenker’s diverticulum who had dysphagia and/or regurgitation and underwent endoscopic myotomy were included. Outcomes assessed included technical success, clinical success, and adverse events.

Results 161 patients were included. Traditional endoscopic septotomy was performed most frequently (137/161, 85.1 %) followed by submucosal dissection of the septum and myotomy (24/161, 14.9 %). The hook knife (43/161, 26.7 %) and needle-knife (33/161, 20.5 %) were used most frequently. Overall, technical and clinical success rates were 98.1 % (158/161) and 78.1 % (96/123), respectively. Adverse events were noted in 13 patients (8.1 %). There was no significant difference in technical and clinical success between traditional septotomy and submucosal dissection groups (97.1 % vs. 95.8 %, P = 0.56 and 75.2 % vs. 90.9 %, P  = 0.16, respectively). Clinical success was higher with the hook knife (96.7 %) compared with the needle-knife (76.6 %) and insulated tip knife (47.1 %). Outcomes were similar between centers performing > 20, 11 – 20, and ≤ 10 procedures.

Conclusions Flexible endoscopic myotomy is an effective therapy for Zenker’s diverticulum, with a low rate of adverse events. There was no significant difference in outcomes between traditional septotomy and a submucosal dissection approach, or with centers with higher volume, though clinical success was higher with the hook knife.



Publikationsverlauf

Eingereicht: 26. März 2020

Angenommen: 14. Juli 2020

Publikationsdatum:
14. Juli 2020 (online)

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