Direct diverticular peroral endoscopic myotomy for the treatment of thoracic esophageal diverticula: technique and outcomes

Julia L. Gauci; Sunil Gupta; Muhammad Abu Arisha; Andrew Tang; Timothy O’Sullivan; Anthony Whitfield; Oliver Cronin; Varan Perananthan; Clarence Kerrison; Eric Y. Lee; Nicholas G. Burgess; Michael J. Bourke

doi:10.1055/a-2182-5853

Endoscopy, Inhaltsverzeichnis

Endoscopy 2024; 56(01): 41-46
DOI: 10.1055/a-2182-5853

Innovations and brief communications

Direct diverticular peroral endoscopic myotomy for the treatment of thoracic esophageal diverticula: technique and outcomes

Autoren

Julia L. Gauci

¹Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
Sunil Gupta

¹Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia

²Westmead Clinical School of Medicine, The University of Sydney, Sydney, Australia
Muhammad Abu Arisha

¹Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
Andrew Tang

¹Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
Timothy O’Sullivan

¹Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia

²Westmead Clinical School of Medicine, The University of Sydney, Sydney, Australia
Anthony Whitfield

¹Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia

²Westmead Clinical School of Medicine, The University of Sydney, Sydney, Australia
Oliver Cronin

¹Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia

²Westmead Clinical School of Medicine, The University of Sydney, Sydney, Australia
Varan Perananthan

¹Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
Clarence Kerrison

¹Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
Eric Y. Lee

¹Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
Nicholas G. Burgess

¹Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia

²Westmead Clinical School of Medicine, The University of Sydney, Sydney, Australia
Michael J. Bourke

¹Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia

²Westmead Clinical School of Medicine, The University of Sydney, Sydney, Australia

Abstract

Background Diverticular peroral endoscopic myotomy (POEM) is an alternative to surgery for the management of symptomatic thoracic esophageal diverticula. Conventionally, this requires proximal tunnel formation but a direct approach may simplify the technique. Herein, we report the outcomes of direct diverticular-POEM (DD-POEM).

Methods We conducted a single-center prospective observational study evaluating DD-POEM. This involved a direct approach to the diverticulum. Success was defined as an Eckardt score of ≤ 3 without the need for reintervention.

Results 10 patients underwent DD-POEM (median age 72 years; interquartile range [IQR] 14.3; male 60 % [n = 6]). Median diverticulum size was 40 mm (IQR 7.5) and median location was 35 cm from the incisors (IQR 8.3). Five patients (50 %) had an underlying dysmotility disorder. The median procedure duration was 60 minutes (IQR 28.8). There were no adverse events. The median hospital stay was 1 day (IQR 0.75). The pre-procedure median Eckardt score of 6 (IQR 4) significantly improved to 0 (IQR 0.75; P < 0.001) at a median follow-up of 14.5 months (IQR 13.8). Success was achieved in all patients.

Conclusions DD-POEM was a safe technique for the management of thoracic esophageal diverticula. Owing to its simplicity and excellent performance it should be further evaluated for the treatment of this disorder.

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Referenzen

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