Peroral Endoscopic Myotomy in the Management of Zenker's Diverticulum: A Retrospective Multicenter Study

Background: Peroral endoscopic myotomy (POEM) is an emerging technique in the treatment of Zenker&rsquo
s diverticulum (ZD). This study aimed to analyze the feasibility of Zenker&rsquo
s POEM (Z-POEM) in a multicenter setting and assess its performance using a validated Kothari-Haber Scoring System newly developed for symptom measurement in ZD. Materials and methods: This was a multicenter retrospective study involving three Polish tertiary referral endoscopic units. The data of consecutive patients with symptomatic ZD treated with Z-POEM in Poland between May 2019 and August 2020 were retrieved and analyzed. Primary outcome measures were technical success and clinical success rate (&lt
3 points in Kothari-Haber Score at 2&ndash
3 months follow-up). Secondary outcome measures included procedures&rsquo
duration, length of hospital stay, and adverse events. Results: 22 patients with symptomatic ZD were included. The mean age was 67.6 (&plusmn
10.7) years, and 14 (63.6%) were male. All but two patients were treatment na&iuml
ve. The average size of the ZD was 30 mm (IQR, 24&ndash
40 mm). Technical success was achieved in all patients (100%), whereas clinical success was 90.9%. The average Kothari-Haber Score was 6.35 before treatment and has dropped to 0.65 after the treatment (p &lt
0.0001). The mean procedure time was 48.8 (&plusmn
19.3) minutes, and the median length of hospital stay was 2 days (IQR, 2&ndash
3). Three patients (13.6%) had post-procedural emphysema, of which two were mild and self-resolving (9.1%), and one was moderate (4.5%) and complicated with laryngeal edema and prolonged intubation. Conclusions: This feasibility study suggests that Z-POEM is a highly effective and safe treatment for ZD, particularly among treatment-na&iuml
ve patients. Comparative studies with other treatment modalities over longer follow-up are warranted.