S1028 Is Peroral Endoscopic Myotomy Superior to Septotomy for Zenker’s Diverticulum? A Systematic Review and Meta-Analysis

Introduction: Zenker’s diverticulum (ZD) management has evolved significantly, transitioning from open surgery to advanced endoscopic techniques with septotomy being the traditional approach. This includes the flexible and rigid endoscopic septotomy. Per oral endoscopic myotomy (POEM) has shown promising safety and efficacy in the treatment of ZD, but comparative data between POEM and septotomy remain sparse. This meta-analysis aimed to compare the efficacy and safety of POEM versus septotomy for ZD. Methods: Electronic databases, including PubMed, Cochrane Central, and ScienceDirect, were searched from inception to January 2025. The risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CIs) were pooled under the random effects model using Review Manager version 5.4.1 for the dichotomous outcomes. The primary and secondary endpoints of interest were technical success, clinical success, re-interventions, and adverse events. The quality assessment was done through the Newcastle Ottawa Scale, whereas publication bias was assessed through funnel plots and Egger’s regression test. Results: Nine studies encompassing 676 patients were included in this meta-analysis. POEM showed a statistically significant increase in clinical success (RR 1.09; 95% CI [1.03,1.16]; P = 0.005; I2 = 0%). Regarding the technical success, no significant difference was observed between the 2 groups (RR 0.99; 95% CI [0.97,1.02]; P = 0.62; I2 = 0%). Other outcomes including the symptom recurrence (RR 0.55; 95% CI [0.25, 1.21]; P = 0.14; I2 = 28%), adverse events (RR 0.59; 95% CI [0.23, 1.51]; P = 0.27; I2 = 58%), procedural time (MD -1.21 min; 95% CI [-9.28, 6.86 ]; P = 0.77; I2 = 85%) and length of hospital stay (MD -0.07; 95% CI [-0.55,0.42 ]; P = 0.79; I2 = 52%) were also comparable between the POEM and septotomy groups. Conclusion: POEM demonstrates a significantly higher clinical success rate compared to traditional endoscopic septotomy in the management of Zenker’s diverticulum, indicating its superior effectiveness in symptom resolution. Despite this advantage, both POEM and septotomy show comparable outcomes in terms of technical success, symptom recurrence, adverse events, procedural time, and length of hospital stay, underscoring that POEM maintains a similar safety profile and procedural feasibility. These findings suggest that POEM not only offers enhanced therapeutic efficacy but also represents a safe and minimally invasive alternative to septotomy.