Sa1294 PERORAL ENDOSCOPIC SEPTOTOMY (POES) VS FLEXIBLE ENDOSCOPIC SEPTOTOMY FOR THE TREATMENT OF SHORT-SEPTUM ZENKER’S DIVERTICULUM: A CASE-MATCHED STUDY

Abstract

The definitive treatment of Zenker’s diverticulum(ZD) is to transect the cricopharyngeal muscle to eliminate the septum between the diverticulum and the upper esophagus. Septotomy performed utilizing a flexible endoscope has been reported as a safe and effective treatment. However, patients with short septum(ss; ≤20mm) ZD still represent a difficult-to-treat subgroup of patients because of the anatomical limitation leading to reduced operating space for both rigid and flexible endoscopic treatments. Recently, third space tunneling approaches such as Z-POEM and Per-Oral Endoscopic Septotomy (POES), have been developed to allow a safer, more complete myotomy. However these techniques have never been compared to the standard flexible septotomy. This is a retrospective analysis, comparing efficacy and safety between septotomy performed by a luminal or a third space approach(POES) for treating ssZD. All patients with ZD who were referred for flexible endoscopic septotomy were included in a prospectively maintained database. Exclusion criteria consisted of septum>20 mm and follow up time shorter than 6 months. Patients were finally selected for final analysis matching age, sex and pre-procedural dysphagia score (Dakkak and Bennett(D&B) dysphagia scale was used). Persistent complete or near-complete resolution of symptoms (D&B 0 or 1) was defined as clinical success. Adverse events according to ASGE lexicon and procedure time were also recorded. Follow up was carried out by patient visits or via telephone calls by a dedicated nurse. Since 2011, 122 patients have been treated for ssZD by third space or standard endoscopic approach. After matching, the two groups (50 patients, 25 patients per group) did not differ in terms of demographics. Clinical success was achieved for 24/25(96%) and 19/25(76%) patients(p<0.05) in a mean follow up time of 12.9±4.8 and 38.0±19.8 months, for POES and standard septotomy group, respectively. Mean procedural time was 14.2±5.2 and 18.7±5.7 respectively. One perforations, managed endoscopically, occurred in the standard septotomy group. No post procedural adverse events occurred. According to the results of this case-matched study, both the endoscopic approaches resulted to be safe strategies. The intrinsic limitations related to restrospective design and different follow up time, prevent definitive conclusions in term of efficacy. However this first evidence supporting a third space over a standard approach, may suggest at least to continue investigating in this direction.