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Diverticular per oral endoscopic myotomy (DPOEM) for esophageal diverticular disease: a systematic review and meta-analysis

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Abstract

The traditional way to tackle Zenker’s diverticulum (ZD) has been flexible endoscopic septum division (FESD). Recently, the concept of per oral endoscopic myotomy has been found useful for managing diverticular diseases of the esophagus and has been termed DPOEM. We performed a systematic review and meta-analysis to evaluate the efficacy and safety of D-POEM in diverticular disease of the esophagus and to compare it with FESD. We systematically searched PubMed and Embase, for studies reporting clinical success, technical success and adverse events in D-POEM alone or D-POEM comparing with FESD. We computed pooled prevalence for D-POEM alone and risk ratio for D-POEM vs FESD using random effect method with inverse variance approach. Subgroup analysis for ZD, non-ZD and mixed diverticulum was conducted. Totally 19 studies including 341 patients were identified reporting on D-POEM. The pooled clinical, technical success and adverse event rates for D-POEM were 87.07%, 95.19% and 10.22%, respectively. The clinical success was significantly better than FESD while the technical success, adverse event rate, procedure time and length of hospital stay were comparable with FESD. The recurrence rate was negligible for D-POEM compared to FESD. On subgroup analysis by dividing into three groups of ZD, non-ZD and mixed, there was no difference between clinical, technical success and adverse event rate among the three groups. D-POEM is an effective and safe technique among both ZD and non-ZD patients and has better clinical success than FESD.

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Authors and Affiliations

  1. Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India

    Harshal S. Mandavdhare, Dayakrishna Jha, Antriksh Kumar, Vishal Sharma & Usha Dutta

  2. Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    M. Praveen Kumar

  3. Surat Institute of Digestive Sciences, Surat, India

    Pankaj Desai

  4. Endoscopy Department, Moscow Clinical Science Centre Named By A.S. Loginov, Moscow, Russia

    Lada Shumkina

  5. Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Pankaj Gupta

  6. Department of Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Harjeet Singh

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  1. Harshal S. Mandavdhare
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Correspondence to Harshal S. Mandavdhare.

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Mandavdhare, H.S., Praveen Kumar, M., Jha, D. et al. Diverticular per oral endoscopic myotomy (DPOEM) for esophageal diverticular disease: a systematic review and meta-analysis. Esophagus 18, 436–450 (2021). https://doi.org/10.1007/s10388-021-00839-9

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