Long term outcomes of zenker's peroral endoscopic myotomy (z-poem) for treatment of zenker's diverticulum

Background and study aims Z-POEM is now an established therapy for symptomatic Zenker's diverticulum (ZD). Short-term follow-up of up to 1-year post Z-POEM suggests excellent efficacy and safety; however, long-term outcomes are not known. Thus, we sought to report on longer-term outcomes (>= 2 years) following Z-POEM for treatment of ZD. Patients and methods This was an International multi-center retrospective study at eight institutions across North America, Europe, and Asia over a 5-year period (from December 3, 2015 to March 13, 2020) of patients who underwent Z-POEM for management of ZD with a minimum 2-year follow-up. The primary outcome was clinical success, defined as improvement in dysphagia score to <= 1 without need for further procedures during the first 6 months. Secondary outcomes included rate of recurrence in patients initially meeting clinical success, rate of reintervention, and adverse events (AEs). Results A total of 89 patients (male 57.3%, mean age 71 +/- 12 years) underwent Z-POEM for treatment of ZD (mean diverticulum size was 3.4 +/- 1.3 cm). Technical success was achieved in 97.8% of patients ( n = 87) with a mean procedure time of 43.8 +/- 19.2 minutes. The median post-procedure hospital stay was 1 day. There were eight AEs (9 %) ( 3 mild, 5 moderate). Overall, clinical success was achieved in 84 patients (94%). Mean dysphagia, regurgitation, and respiratory scores all improved dramatically from 2.1 +/- 0.8, 2.8 +/- 1.3, and 1.8 +/- 1.6 pre-procedure to 0.13 +/- 0.5, 0.11 +/- 0.5, and 0.05 +/- 0.4, respectively, post-procedure at most recent follow-up ( all P < 0.0001). Recurrence occurred in six patients (6.7 %) during a mean length of follow-up of 37 months (range 24 to 63 months). Conclusions Z-POEM is a highly safe and effective treatment for Zenker's diverticulum with durable treatment effect to at least 2 years.