Peroral Endoscopic Myotomy for the Treatment of Esophageal Diverticula: A Systematic Review and Meta-analysis.

Abstract

BACKGROUND:

There is limited evidence on the efficacy of peroral endoscopic myotomy (POEM) in patients with esophageal diverticula.

AIMS:

This meta-analysis aimed to assess the efficacy and safety profile of POEM in patients with Zenker (ZD) and epiphrenic diverticula.

METHODS:

With a literature search through August 2020, we identified 12 studies (300 patients) assessing POEM in patients with esophageal diverticula. The primary outcome was treatment success. Results were expressed as pooled rates and 95% confidence intervals.

RESULTS:

Pooled rate of technical success was 95.9% (93.4%-98.3%) in ZD patients and 95.1% (88.8%-100%) in patients with epiphrenic diverticula. Pooled rate of treatment success was similar for ZD (90.6%, 87.1%-94.1%) and epiphrenic diverticula (94.2%, 87.3%-100%). Rates of treatment success were maintained at 1 year (90%, 86.4%-97.4%) and 2 years (89.6%, 82.2%-96.9%) in ZD patients. Pooled rate of symptom recurrence was 2.6% (0.9%-4.4%) in ZD patients and 0% in patients with epiphrenic diverticula. Pooled rates of adverse events and severe adverse events were 10.6% (4.6%-16.6%) and 3.5% (0%-7.4%) in ZD and 8.4% (0%-16.8%) and 8.4% (0%-16.8%) in epiphrenic diverticula, respectively.

CONCLUSION:

POEM represents an effective and safe therapy for the treatment of esophageal diverticula.

• Authors: Antonio Facciorusso, Daryl Ramai, Yervant Ichkhanian, Rena Yadlapati, Vito Annese, Sachin Wani, Mouen A Khashab
• Journal: Journal of clinical gastroenterology (J Clin Gastroenterol) 2022 Nov-Dec 01 Vol. 56 Issue 10 Pg. 853-862 ISSN: 1539-2031 [Electronic] United States
• PMID: 34608024 (Publication Type: Journal Article, Meta-Analysis, Systematic Review)
• Copyright: Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

Topics

• Digestive System Surgical Procedures
• Diverticulum, Esophageal (diagnosis, etiology, surgery)
• Esophageal Achalasia (etiology)
• Esophageal Sphincter, Lower
• Humans
• Myotomy (adverse effects, methods)
• Natural Orifice Endoscopic Surgery (adverse effects)
• Treatment Outcome