Peroral endoscopic myotomy alone is effective for esophageal motility disorders and esophageal epiphrenic diverticulum:
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and Other Interventional Techniques
Peroral endoscopic myotomy alone is effective for esophageal motility disorders and esophageal epiphrenic diverticulum: a retrospective single‑center study Masato Kinoshita1 · Shinwa Tanaka1 · Fumiaki Kawara1 · Hiroya Sakaguchi1 · Hirofumi Abe1 · Ryusuke Ariyoshi1 · Takashi Toyonaga2 · Yuzo Kodama1 Received: 3 July 2019 / Accepted: 24 December 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Esophageal epiphrenic diverticulum (ED) is associated with esophageal motility disorder (EMD). If a diverticulum associated with EMD is enlarging with worsening symptoms, surgical intervention, including laparoscopic epiphrenic diverticulectomy with myotomy and fundoplication, is indicated. However, some studies suggest that myotomy alone, with less adverse events, is sufficient to improve symptoms. Additionally, peroral endoscopic myotomy (POEM) is considered effective and safe for EMD. Since theoretically, POEM is endoscopic Heller myotomy, POEM without diverticulectomy is considered a less invasive, promising treatment option for EMD and ED. We aimed to determine the efficacy and safety of POEM alone for ED with EMD. Methods This single-center study was retrospective. A total of 298 patients underwent POEM in Kobe University Hospital from April 2015 to October 2018. Of them, 14 patients had ED. Procedure-related outcomes and treatment outcomes 3 months post POEM were evaluated in these patients. Results The median maximum ED diameter was 29 (range 9–90) mm; and the median POEM procedure time, 77.5 (range 41–123) min. Pneumoperitoneum, which required needle decompression, occurred in one patient, but no fatal adverse events occurred. The median Eckardt score significantly decreased from 5 [range 2–11] pre POEM to 0 [range 0–2] post POEM (P
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