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▶ Table1 Baseline demographics.
Total (n = 245)
Z-POEM (n=119)
Endoscopic septotomy
P value
Flexible (n = 86)
Rigid (n = 40)
Female sex, n (%)
110 (44.9)
52 (43.7)
38 (44.2)
20 (50.0)
0.79
Age, mean (SD), years
72.63 (12.37)
72.49 (13.23)
72.21 (12.37)
73.98 (9.60)
0.74
Symptoms, n (%)
▪ Dysphagia
230 (93.9)
116 (97.5)
77 (89.5)
37 (92.5)
0.06
▪ Regurgitation
165 (67.3)
79 (66.4)
64 (74.4)
22 (55.0)
0.12
▪ Weight loss
51 (20.8)
18 (15.1)
24 (27.9)
9 (22.5)
0.08
▪ Halitosis
22 (9.0)
13 (10.9)
8 (9.3)
1 (2.5)
0.27
Prior Zenker ’ s diverticulum treatment, n (%)
46 (18.8)
25 (21.0)
14 (16.3)
7 (17.5)
0.61
Baseline diverticulum size, mean (SD), mm 32.96 (14.55)
34.85 (14.68)
28.65 (12.33)
36.47 (16.73)
0.003
ASA score, mean (SD)
2.35 (0.69)
2.45 (0.69)
2.32 (0.71)
2.15 (0.69)
0.05
Sedation, n (%)
<0.001
▪ General anesthesia
232 (94.7)
119 (100)
73 (84.9)
40 (100)
▪ Conscious sedation
13 (5.3)
0
13 (15.1)
0
Antibiotics, n (%)
0.04
▪ None
27 (11.0)
7 (5.9)
14 (16.3)
6 (15.0)
▪ Periprocedure
215 (87.8)
111 (93.3)
70 (81.4)
34 (85.0)
▪ Unknown
3 (1.2)
1 (0.8)
2 (2.3)
0
Z-POEM, Zenker ’ s peroral endoscopic myotomy; SD, standard deviation; ASA, American Society of Anesthesiologists.
among the three groups. This included mean age (72.49 [SD 13.23] years for Z-POEM vs. 72.21 [SD 12.37] years for flexible endoscopic septotomy vs. 73.98 [SD 9.60] years for rigid endo scopic septotomy; P = 0.74), sex (female 43.7 % vs. 44.2 % vs. 50.0 %, respectively; P = 0.79), and prior treatment for Zenker ’ s diverticulum (21.0 % vs. 16.3 % vs. 17.5 %; P =0.61) ( ▶ Table1 ). The American Society of Anesthesiologists score was highest in the Z-POEM group, followed by the flexible then rigid endo scopic septotomy groups (2.45 [SD 0.69], 2.32 [SD 0.71], and 2.15 [SD 0.69], respectively; P = 0.05). The mean size of the di verticulum was smallest in the flexible endoscopic septotomy group, followed by Z-POEM and rigid endoscopic septotomy groups (28.65 [SD 12.33] mm, 34.85 [SD 14.68], and 36.47 [SD 16.73] mm, respectively; P =0.003). The most common symptoms at the time of the index proce dure were dysphagia (93.9 %) and regurgitation (67.3 %), with a mean preprocedure dysphagia score of 1.74 (SD 1.04]. Other baseline symptoms included weight loss (20.8 %) and halitosis (8.9 %). The majority of procedures were performed under gen eral anesthesia (94.7 %). Antibiotics were administered more frequently during Z-POEM procedures ( P =0.04) ( ▶ Table1 ). Procedural and clinical outcomes Technical success was achieved in 95.0 % of Z-POEM procedures (113/119, 95 % confidence interval [CI] 90.97 – 98.95), 95.3 % of flexible endoscopic septotomy procedures (82/86, 95 %CI
90.81 – 99.89), and 87.5 % of rigid endoscopic septotomy proce dures (35/40, 95 %CI 76.79 – 98.21) ( P = 0.18). The mean proce dure time for flexible endoscopic septotomy (33.72 [SD 22.34] minutes) was significantly shorter than that for both rigid endoscopic septotomy (54.03 [SD 22.45] minutes; P <0.001) and Z-POEM (46.13 [SD 20.34] minutes; P <0.001). The mean length of hospital stay was 1.47 [SD 0.97] days in the flexible endoscopic septotomy group, followed by 1.66 [SD 1.55] days in the Z-POEM group and 4.94 [14.75] days in the rigid endo scopic septotomy group ( P = 0.006). Resolution of Zenker ’ s di verticulum on barium esophagram was similar in all three groups (75% in the Z-POEM group, 68 % in the flexible endo scopic septotomy group, and 80 % in the rigid endoscopic sep totomy group; P =0.34). Overall, 23/245 patients (9.4 %) were lost to follow-up (9/ 119 Z-POEM, 11/86 flexible endoscopic septotomy, and 3/40 ri gid endoscopic septotomy). Patients who were lost to follow-up were not included in analysis of clinical success or failure. Clini cal success was evaluated at the first post-procedure follow-up in the remaining 222 patients, after a mean of 148.92 (SD 154.8) days post-procedure. The rate of clinical success was equivalent between the three groups: 92.7 % (102/110) in the Z-POEM group, 89.2 % (33/37) in the rigid endoscopic septo tomy group, and 86.7 % (65/75) in the flexible endoscopic sep totomy group ( P = 0.26). Clinical failure occurred in 22 patients (10 flexible endoscopic septotomy, 8 Z-POEM, 4 rigid endo-
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Al Ghamdi Sarah S et al. Zenker ’ s peroral endoscopic … Endoscopy 2022; 54: 345 – 351 | © 2021. Thieme. All rights reserved.
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