Impact of prior treatment on feasibility and outcomes of Zenker's peroral endoscopic myotomy (Z-POEM)

Background Zenker's peroral endoscopic myotomy (Z-POEM) is a novel procedure for the management of symptomatic Zenker's diverticulum. This study aims to report the technical feasibility and outcomes of Z-POEM in the management of Zenker's diverticulum after prior failed interventions. Methods Patients with persistent or recurrent symptoms after prior endoscopic and/or surgical intervention for Zenker's diverticulum were retrospectively included. The primary outcome was clinical success, defined as complete or near complete resolution of dysphagia (dysphagia score of 0 or 1) without the need for repeat endoscopic or surgical intervention during follow-up. Results Z-POEM was technically successful in 30/32 patients (93.8%). Clinical success was achieved in 29/30 patients (96.7%), and Z-POEM significantly reduced the median (interquartile range [IQR]) dysphagia score of patients from 2 (1-2) to 0 (0) (P<0.001) over a median duration of follow up of 166 days (IQR 39-566). Four patients (12.5%) had adverse events (two inadvertent mucosotomies and two leaks found on post-procedural esophagrams). Conclusion Z-POEM is feasible, safe, and effective in the majority of patients with recurrent symptoms after prior surgical or endoscopic interventions.