Abstract
Esophageal diverticula can cause significant symptoms and affect the quality of life. There has been recent interest in the use of peroral endoscopic myotomy in the management of esophageal diverticula (D-POEM). In this meta-analysis, we have evaluated the efficacy and safety of D-POEM in the management of esophageal diverticula. Several databases were reviewed from inception to 6/19/2020 to identify the studies evaluating the feasibility, efficacy and safety of D-POEM in the management of esophageal diverticula. Our outcomes of interest were technical success, adverse events and difference in mean pre- and post-procedure symptom score. We performed subgroup analysis including patients with Zenker’s diverticulum who underwent POEM (Z-POEM). Pooled rates with 95% confidence intervals (CI) for all outcomes were calculated using random effect model. We calculated standard mean difference (SMD) with 95% CI to compare mean pre- and post-procedure symptom score. We included 7 studies with 233 patients. For D-POEM, pooled rates (95% CI) for technical success and adverse events were 95% (91%, 97%) and 6% (3%, 10%) respectively. For Z-POEM, pooled rates (95% CI) for technical success and adverse events were 95% (90%, 97%) and 6% (3%, 10%) respectively. Mean post-procedure symptom score for all patients who underwent D-POEM was significantly lower compared to mean pre-procedure symptom score, SMD (95% CI) 2.17 (1.51, 2.83). This meta-analysis demonstrated that D-POEM is a safe and feasible option for patients with symptomatic esophageal diverticula.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Thomas ML, Anthony AA, Fosh BG, Finch JG, Maddern GJ. Oesophageal diverticula. Br J Surg. 2001;88:629–642.
Sato H, Takeuchi M, Hashimoto S, et al. Esophageal diverticulum: new perspectives in the era of minimally invasive endoscopic treatment. World J Gastroenterol.. 2019;25:1457–1464.
Rosati R, Fumagalli U, Elmore U, de Pascale S, Massaron S, Peracchia A. Long-term results of minimally invasive surgery for symptomatic epiphrenic diverticulum. Am J Surg. 2011;201:132–135.
Yuan Y, Zhao YF, Hu Y, Chen LQ. Surgical treatment of Zenker’s diverticulum. Dig Surg. 2013;30:207–218.
Ishaq S, Hassan C, Antonello A, et al. Flexible endoscopic treatment for Zenker’s diverticulum: a systematic review and meta-analysis. Gastrointest Endosc.. 2016;83:1076-89.e5.
Zeng X, Bai S, Zhang Y, Ye L, Yuan X, Hu B. Peroral endoscopic myotomy for the treatment of esophageal diverticulum: an experience in China. Surg Endosc. 2020. https://doi.org/10.1007/s00464-020-07593-6.
Yang J, Novak S, Ujiki M, et al. An international study on the use of peroral endoscopic myotomy in the management of Zenker’s diverticulum. Gastrointest Endosc.. 2020;91:163–168.
Al Ghamdi SS, Farha J, Meybodi MA, et al. 51 International multicenter study comparing z-poem and flexible/rigid endoscopic zenker’s diverticulotomy. Gastrointestinal Endoscopy.. 2020;91:AB3–AB4.
Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.
Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283:2008–2012.
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25:603–605.
Basile P, Gonzalez JM, Le Mouel JP, Irarrazaval R, Caillo L, Barthet M. Per-oral endoscopic myotomy with septotomy for the treatment of distal esophageal diverticula (D-POEM). Surg Endosc. 2020;34:2321–2325.
Maydeo A, Patil GK, Dalal A. Operative technical tricks and 12-month outcomes of diverticular peroral endoscopic myotomy (D-POEM) in patients with symptomatic esophageal diverticula. Endoscopy. 2019;51:1136–1140.
Li X, Zhang W, Yang J, et al. Safety and efficacy of submucosal tunneling endoscopic septum division for epiphrenic diverticula. Endoscopy.. 2019;51:1141–1145.
Michel Kahaleh MG, Noah Y. Mahpour, Romy Bareket, Daniel Marino, Prashant Kedia, Elizabeth S. John, Shruti Patel, Deepak Bommisetty, Jose Nieto, Ameya A. Deshmukh, Nikolas P. Eleftheriadis, Haroon M. Shahid, Avik Sarkar, Amy Tyberg, Amol Bapaye, editor Per oral endoscopic myotomy for zenker’s diverticulum: a novel and safer technique over septotomy? Digestive Disease Week; 2019.
Chan DSY, Foliaki A, Lewis WG, Clark GWB, Blackshaw G. Systematic Review and Meta-analysis of SurgicalTreatment of Non-Zenker’s Oesophageal Diverticula. J Gastrointest Surg. 2017;21:1067–1075.
Sorensen HT, Lash TL, Rothman KJ. Beyond randomized controlled trials: a critical comparison of trials with nonrandomized studies. Hepatology. 2006;44:1075–1082.
Funding
This project was not funded from any source.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors have no relevant conflicts of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Kamal, F., Khan, M.A., Lee-Smith, W. et al. Peroral Endoscopic Myotomy Is a Safe and Feasible Option in Management of Esophageal Diverticula: Systematic Review and Meta-Analysis. Dig Dis Sci 66, 3242–3249 (2021). https://doi.org/10.1007/s10620-020-06678-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-020-06678-5