BACKGROUND AND AIMS Epinephric diverticula are frequently associated with esophageal motility disorder. Their management implies surgery, with 15% morbidity and 3% mortality rates. Flexible endoscopy could be an effective and safer approach for treating esophageal diverticulum with motility disorder. We report our experience of seven consecutive cases treated with per-oral endoscopic submucosal septotomy and myotomy (D-POEM). METHODS Seven consecutive patients were referred for symptomatic non-zenker's esophageal diverticulum. The steps of the procedure were as follows: (i) analysis of the esophageal anatomy; (ii) vertical mucosal incision just above the upper edge of the diverticulum; (iii) submucosal tunneling by submucosal dissection, alongside the submucosal window of the diverticulum and the downstream septum; (iv) identification of the septum and the diverticular area; (v) diverticular septotomy followed by antegrade esocardial myotomy up to 2 cm below the cardia; and (vi) closure of the mucosal incision. RESULTS Three men and four women aged from 62 to 90 years were treated. Four patients had a diet with adapted texture before the treatment and five patients had weight loss (4 kg to 24 kg). At preoperative evaluation, all had an esophageal motility disorder at high-resolution manometry. The procedures were successfully performed in all the patients without per-operative complications. During the 30 postoperative days, no significant adverse events occurred. Three months after treatment, six patients (85%) had clinical improvement with complete or partial regression of dysphagia. All the patients stabilized or gained weight after the treatment. CONCLUSION The D-POEM technique is a mini-invasive effective and safe technique to treat symptoms due to both esophageal motility disorder and distal esophageal diverticula. It could be a very interesting solution for non-surgical patients in the first time that could be extended to other patients after favorable larger series.

中文翻译：

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经口内镜下肌膜切开术联合切开术治疗远端食管憩室（D-POEM）。

背景与目的肾上腺憩室经常与食道运动障碍有关。他们的管理意味着手术，发病率为15％，死亡率为3％。柔性内窥镜检查可能是一种治疗运动性疾病的食管憩室的安全有效的方法。我们报告了我们的经口内镜下黏膜下隔膜切开术和肌切开术（D-POEM）连续治疗的七例病例的经验。方法连续7例因有症状的非Zenker食管憩室被转诊。该过程的步骤如下：（i）食管解剖分析；（ii）在憩室上缘正上方的垂直粘膜切口；（iii）通过粘膜下剥离术，在憩室的粘膜下窗口和下游隔片旁边进行粘膜下穿刺；（iv）识别中隔和憩室区域；（v）憩室切开术，然后进行the门肌切开术，直至below门下方2 cm处；（vi）闭合粘膜切口。结果治疗年龄从62岁到90岁的三男四女。四名患者在治疗前饮食具有适应性的饮食，五名患者体重减轻（4 kg至24 kg）。在术前评估中，所有患者在高分辨率测压下均患有食管运动障碍。该手术在所有无手术并发症的患者中均成功完成。术后30天内，未发生重大不良事件。治疗三个月后，有6名患者（85％）出现了吞咽困难的完全或部分消退的临床改善。所有患者在治疗后稳定或体重增加。结论D-POEM技术是一种微创有效且安全的技术，可治疗因食管运动障碍和食管远端憩室引起的症状。对于非手术患者而言，这可能是一个非常有趣的解决方案，可以在扩大规模后扩大到其他患者。