Peroral endoscopic myotomy (POEM) has been used to treat esophageal diverticula, although its effectiveness has not been well-studied. The purpose of this systematic review was to evaluate the efficacy and safety of POEM for treating Zenker (ZD) and epiphrenic diverticula.
About 12 studies evaluating POEM in patients with esophageal diverticula were found after a literature search was conducted up until August 2020 (involving 300 patients). In this case, therapeutic efficacy was the main metric of interest. Pooled rates and 95% CI were used to present the findings. Overall, 95.9% of patients with ZD and 95.1% of patients with epiphrenic diverticula experienced technical success (range, 93.4%-98.3% and 88.8%-100%) respectively.
The success rates for treating ZD (90.6%, 87.1%-94.1%) and epiphrenic diverticula (94.2%, 87.3%-100%), when pooled, were comparable. For ZD patients, the rates of treatment success at both 1 and 2 years were 90% (range, 86.4%-97.4%) and 89.6% (range, 82.2%-96.9%), respectively. Among those with ZD, the pooled rate of symptom recurrence was 2.6% (0.9%-4.4%), while among those with epiphrenic diverticula, it was 0%.
The incidence of adverse events was 8.4% (0%-16.8%) in patients with epiphrenic diverticula and 10.6% (4.6%-16.6%) in patients with ZD, with the rates of serious adverse events being 3.5% (0%-7.4%) and 8.4% (0%-16.8%), respectively. When it comes to dealing with esophageal diverticula, POEM is a therapeutic option that has proven to be both successful and safe.