Z-Poem As A Treatment Option For Zenker'S Diverticulum: Our Experience At A Tertiary Care Centre In India

Background This study was aimed to evaluate efficacy and safety of Z-peroral endoscopic myotomy (Z-POEM; submucosal tunneling endoscopic myotomy) for Zenker's diverticulum (ZD).Methods This is a retrospective study at a single tertiary care center in India. The Z-POEM technique was performed using principles of submucosal tunneling endoscopy with prior experience from POEM technique for achalasia cardiaResults Sixteen patients (male, 62.5%; mean age, 73.2 5.2 years) were included with a mean Charleson's comorbidity index of 4.32. The mean size of ZD was 34.8 +/- 10.0 mm. The technical success rate was 100%. Clinical success was achieved in 100% (16/16) with a decrease in mean dysphagia score from 2.9 to 0.2 (p <0.0001). The mean procedure time was 47 +/- 7.9 minutes and mean length of septotomy was 31.9 +/- 9.4 mm. The mean length of hospital stay was 1.2 +/- 0.4 days. No major adverse events were noted. Capnomediastinum was noted in two cases on follow-up Gastrografin study after 24 hours (12.5%). This did not merit any treatment. One patient had intraprocedural bleed which was controlled easily. At the 18-month follow-up, two (12.5%) patients reported dysphagia recurrence (Dakkak and Bennett score 1) but did not require repeat intervention.Conclusion Endoscopic management of ZD using the POEM technique is a promising technique with improved efficacy and safety. However, long-term follow-up is needed to ensure the durability of response.