Submucosal Tunnelling Techniques for Zenker’S Diverticulum: A Systematic Review of Early Outcomes With Pooled Analysis

Aims In the last decade, flexible endoscopic septotomy has been reported as a safe and effective treatment for Zenker’s diverticulum (ZD). More recently, novel endoscopic submucosal tunneling techniques, namely standard Z-POEM (Zenker PerOral Endoscopic Myotomy) and POES (PerOral Endoscopic Septotomy) (Fig. 1), have been proposed in order to obtain complete muscular septum exposure and deeper myotomy. The aim of this study is to provide a systematic review with meta-analysis of the first experiences of third space approaches for ZD. Methods Electronic databases (Medline, Scopus, EMBASE) were searched up to October 2020. Studies including patients with symptomatic ZD who underwent endoscopic treatment by submucosal tunneling technique were eligible. Procedural, clinical, and safety outcomes were assessed by pooling data with a random-effect model to obtain a proportion with a 95 % confidence interval. Results Ten retrospective studies were eligible for inclusion (229 patients).Six studies were performed in the United States, 2 in Europe, and 2 in Asia. Most of the studies (n = 7) were single-center experiences, and three studies involved multiple centers. Endoscopic pyloromyotomy was feasible in the 97.3 %(I 2 = 0 %) of patients. In most of the studies (n = 7, 166 patients) authors used the standard Z-POEM technique reporting a technical success of 97.5 % (I 2 = 0 %), in a mean procedural time of 44.3 ± 7.5 minutes. In the remaining 3 studies including POES approach performed on 63 patients, the technical success rate was 96.5 % (I 2 =0 %), in a mean procedural time of 20.4 ± 9.3 minutes. Clinical success was achieved after 93.4 %(I 2 =0 %) of procedures with comparable rates between standard Z-POEM and POES(93,7 % vs 91.1 %, respectively). The overall adverse events rate was 5.3 % (I 2 =0 %)with comparable rates between standard Z-POEM and POES (5.2 % vs 7.7 %, respectively). Conclusions Flexible endoscopic treatment of ZD performed by a submucosal tunnelling technique appears to be a feasible option, with convincing data in terms of safety and promising clinical results in the short term. Citation: Spadaccini M, Maselli R, Thoguluva Chandrasekar V et al. eP34 SUBMUCOSAL TUNNELLING TECHNIQUES FOR ZENKER’S DIVERTICULUM: A SYSTEMATIC REVIEW OF EARLY OUTCOMES WITH POOLED ANALYSIS. Endoscopy 2021; 53: S108. Publication History Publication Date: 19 March 2021 (online) © 2021. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany