Efficacy and safety of peroral endoscopic myotomy for esophageal diverticula

Abstract

Background Epiphrenic diverticula are rare and mainly occur in patients with underlying esophageal motility disorders. The current standard treatment is surgical diverticulectomy often combined with myotomy and is associated with significant adverse event rates. The aim of this study is to examine the efficacy and safety of peroral endoscopic myotomy in reducing esophageal symptoms in patients with esophageal diverticula. Methods We performed a retrospective cohort study including patients with an esophageal diverticulum who underwent POEM between October 2014 and December 2022. After informed consent, data was extracted from medical records and patients completed a survey by telephone. Primary outcome was treatment success, defined as Eckardt score below four with a minimal reduction of two points. Results Seventeen patients (mean age 71 years, 41.2% female) were included. Achalasia was confirmed in 13 patients (13/17, 76.5%), Jackhammer esophagus in two patients (2/17, 11.8%), diffuse esophageal spasm in one patient (1/17, 5.9%) and in one patient no esophageal motility disorder was found (1/17, 5.9%). Treatment success was 68.8% and only one patient (6.3%) underwent retreatment (pneumatic dilatation). Median Eckardt scores decreased from seven to one after POEM (p < 0.001). Mean size of the diverticula decreased from 3.6 cm to 2.9 cm after POEM (p < 0.001). Clinical admission was one night for all patients. Adverse events occurred in two patients (11.8%) which were classified as grade II and IIIa (AGREE classification). Conclusion POEM is effective and safe to treat patients with esophageal diverticula and an underlying esophageal motility disorder.