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Per-oral endoscopic myotomy with septotomy for the treatment of distal esophageal diverticula (D-POEM)

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Abstract

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.

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Abbreviations

POEM:

Per-oral endoscopic myotomy

HRM:

High-resolution manometry

ESD:

Endoscopic submucosal dissection

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Funding

No funding, current care.

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Authors and Affiliations

  1. Digestive Endoscopy Unit, Gastroenterology Department, University Hospital of Rouen, 76031, Rouen Cedex, France

    Paul Basile

  2. Digestive Endoscopy Unit, Gastroenterology Department, Hopital Nord, APHM, Marseille, France

    Jean-Michel Gonzalez & Marc Barthet

  3. Digestive Endoscopy Unit, Gastroenterology Department, University Hospital of Amiens, Amiens, France

    Jean-Philippe Le Mouel

  4. Gastroenterology Department, Clinica Davila, Santiago, Chile

    Rodrigo Irarrazaval

  5. Gastroenterology Department, University Hospital of Nîmes, Nîmes, France

    Ludovic Caillo

Authors
  1. Paul Basile
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  2. Jean-Michel Gonzalez
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  3. Jean-Philippe Le Mouel
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  4. Rodrigo Irarrazaval
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  5. Ludovic Caillo
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  6. Marc Barthet
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Corresponding author

Correspondence to Paul Basile.

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Disclosures

Drs Paul BASILE, Jean-Philippe LE MOUEL and Rodrigo Irarrazaval have no conflicts of interest or financial ties to disclose. Jean-Michel GONZALEZ and Marc BARTHET have a research grant from Boston Scientific to disclose. Dr Ludovic CAILLO is on the speaker’s bureau of Abbvie, Norgine, Janssen, Pfizer, Takeda, and Amgen.

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Basile, P., Gonzalez, JM., Le Mouel, JP. et al. Per-oral endoscopic myotomy with septotomy for the treatment of distal esophageal diverticula (D-POEM). Surg Endosc 34, 2321–2325 (2020). https://doi.org/10.1007/s00464-019-07354-0

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  • DOI: https://doi.org/10.1007/s00464-019-07354-0

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