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The role of peroral endoscopic myotomy for Zenker's diverticulum: a systematic review and meta-analysis

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Abstract

Background

Zenker’s peroral endoscopic myotomy (Z-POEM) has revolutionized the therapeutic strategy for Zenker’s diverticulum (ZD) with promising results. We conducted this meta-analysis to estimate the safety and efficacy of Z-POEM for ZD and compare the feasibility and effectiveness of Z-POEM with that of flexible endoscopic septotomy (FES).

Methods

A comprehensive literature search was conducted in PubMed, EMBASE, Web of Science, and Cochrane Library databases to query for studies that assessed the safety and efficacy of Z-POEM for ZD. All articles published from inception to July 31, 2021 were included. The primary outcomes were the overall technical success rate, clinical success rate, incidence of adverse events, and clinical recurrence rate.

Results

Eleven studies involving 357 patients undergone Z-POEM were included. Overall, the quality of included studies was above average, with five studies rated as high quality and six ranked as moderate quality. The overall pooled technical success rate for Z-POEM was 96.3% (95% confidence interval [CI] 93.6–97.9%; I2 = 0%). The total pooled clinical success rate for Z-POEM was 93.0% (95% CI 89.4–95.4%; I2 = 0%). The pooled incidence of adverse events for Z-POEM was 12.4% (95% CI 9.1–16.7%; I2 = 0%). The pooled clinical recurrence rate for Z-POEM was 11.2% (95% CI 7.6–16.2%; I2 = 0%). The clinical success for Z-POEM was significantly better than that of FES (relative risk [RR]: 1.11; CI 95% 1.03–1.18; p = 0.004, I2 = 0%), while there were no significant differences in technical success, adverse events, and clinical recurrence between Z-POEM and FES.

Conclusion

Z-POEM could be an effective and safe therapeutic modality for ZD, and even has a slightly higher clinical success rate than FES. However, comparative studies with long-term follow-up will be needed to further confirm our finding.

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Abbreviations

POEM:

Peroral endoscopic myotomy

Z-POEM:

Zenker’s peroral endoscopic myotomy

D-POEM:

Diverticular peroral endoscopic myotomy

FES:

Flexible endoscopic septotomy

ZD:

Zenker’s diverticulum

SD:

Standard deviation

RR:

Relative risk

MD:

Mean difference

SMD:

Standardized mean difference

CI:

Confidence interval

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Acknowledgements

This study is independent research funded by the following grants: Cooperation Project of Southwest Medical University and Luzhou Government (No. 2019LZXNYDJ24), Youth Foundation of Southwest Medical University (No. 0903-00031099), Doctoral research start-up funding project of Affiliated Hospital of Southwest Medical University (No. 16229).

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Author notes

  1. Han Zhang, Shu Huang and Huifang Xia have contributed equally to this work.

Authors and Affiliations

  1. Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Street Taiping No.25, Region Jiangyang, Luzhou, 646099, Sichuan Province, China

    Han Zhang, Huifang Xia, Lei Shi, Xinyi Zeng, Jiao Jiang, Wensen Ren, Yan Peng, Muhan Lü & Xiaowei Tang

  2. Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China

    Han Zhang, Huifang Xia, Lei Shi, Xinyi Zeng, Jiao Jiang, Wensen Ren, Yan Peng, Muhan Lü & Xiaowei Tang

  3. Department of Gastroenterology, The People’s Hospital of Lianshui, Huaian, China

    Shu Huang

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Contributions

Study conception and design: XT; acquisition of data: JJ, WR; critical revision: LS, XZ; interpretation of data: YP, ML; drafting of manuscript: HZ, SH, HX; revision of manuscript: XT; and final approval of manuscript: XT.

Corresponding authors

Correspondence to Muhan Lü or Xiaowei Tang.

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Disclosures

Han Zhang, Shu Huang, Huifang Xia, Lei Shi, Xinyi Zeng, Jiao Jiang, Wensen Ren, Yan Peng, Muhan Lü, and Xiaowei Tang declare that they have no conflicts of interest or financial ties to disclose.

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Zhang, H., Huang, S., Xia, H. et al. The role of peroral endoscopic myotomy for Zenker's diverticulum: a systematic review and meta-analysis. Surg Endosc 36, 2749–2759 (2022). https://doi.org/10.1007/s00464-022-09021-3

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