Introduction: 

Endoscopic management of Zenker diverticuli (ZD) has traditionally been via septotomy technique. The recent development of tunneling technique has shown to be both efficacious and safe. The aim of this study is to evaluate the tunneling technique using per oral endoscopic myotomy (Z-POEM) versus septotomy.

Methods: 

Patients who underwent endoscopic management of ZD either by Z-POEM or septotomy from March 2017 until November 2020 from 9 international academic centers were included. Demographics, clinical data preprocedure and postprocedure, procedure time, adverse events, and hospital length of stay were analyzed.

Results: 

A total of 101 patients (mean age 74.9 y old, 55.4% male) were included: septotomy (n=49), Z-POEM (n=52). Preprocedure Functional Oral Intake Scale score and Eckardt score was 5.3 and 5.4 for the septotomy group and 5.9 and 5.15 for the Z-POEM group. Technical success was achieved in 98% of the Z-POEM group and 100% of the septotomy group. Clinical success was achieved in 84% and 92% in the septotomy versus Z-POEM groups. Adverse events occurred in 30.6% (n=15) in septotomy group versus 9.6% (n=5) in the Z-POEM group (P=0.017). Reintervention for ongoing symptoms occurred in 7 patients in the septotomy group and 3 patients in the Z-POEM group. Mean hospital length of stay was shorter for the Z-POEM group, at 1.5 versus 1.9 days.

Conclusions: 

A tunneling technique via the Z-POEM procedure is an efficacious and safe endoscopic treatment for ZD. Z-POEM is a safer procedure with a statistically significant reduction in adverse events compared with traditional septotomy technique.

中文翻译：

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经口腔内窥镜肌切开术治疗 Zenker 憩室：与隔膜切开术相比，这是一种新颖且优越的技术？

介绍： 

Zenker 憩室 (ZD) 的内镜治疗传统上是通过隔膜切开术技术进行的。隧道技术的最新发展已被证明既有效又安全。本研究的目的是评估经口腔内镜肌切开术 ( Z-POEM ) 与隔膜切开术的隧道技术。

方法： 

2017 年 3 月至 2020 年 11 月期间，来自 9 个国际学术中心通过Z-POEM或鼻中隔切开术接受 ZD 内镜治疗的患者被纳入研究。分析了人口统计学、术前和术后的临床数据、手术时间、不良事件和住院时间。

结果： 

共有 101 名患者（平均年龄 74.9 岁，55.4% 男性）被纳入：中隔切开术 (n=49)、Z-POEM (n=52)。鼻中隔切开组术前功能性口腔摄入量表评分和 Eckardt 评分分别为 5.3 和 5.4，Z-POEM组分别为 5.9 和 5.15。Z-POEM组的 98% 和隔膜切开组的 100%取得了技术成功。鼻中隔切开术组与Z-POEM组的临床成功率分别为 84% 和 92%。鼻中隔切开术组的不良事件发生率为 30.6% (n=15)，而Z-POEM组的不良事件发生率为 9.6% (n=5)（P =0.017）。中隔切开术组中的 7 名患者和Z-POEM组中的 3 名患者因持续症状而接受了重新干预。Z-POEM组的平均住院时间较短，分别为 1.5 天和 1.9 天。

结论： 

通过Z-POEM手术的隧道技术是一种有效且安全的 ZD 内镜治疗方法。Z-POEM是一种更安全的手术，与传统的隔膜切开术技术相比，不良事件在统计学上显着减少。