POEM-based endoscopic myotomy for esophageal diverticulum: a case series study

BACKGROUND AND AIMS: In recent years, the submucosal tunneling principle underlying Peroral endoscopic myotomy (POEM) has emerged as a minimally invasive endoscopic option for the treatment of esophageal diverticulum (ED). However, evidence regarding its effectiveness across different types of ED remains limited. This study aimed to evaluate the clinical efficacy and safety of endoscopic myotomy for the management of esophageal diverticulum. METHODS: This single-center retrospective case series included patients with ED who underwent POEM-based endoscopic myotomy at the East Hospital Affiliated to Tongji University between February 2019 and February 2023. RESULTS: Seven patients (aged 44 to 80 years; four males) were included, comprising three with epiphrenic diverticulum, three with Zenker diverticulum (ZD), and one with mid-esophageal diverticulum. Different subtypes received tailored POEM-based procedures: epiphrenic diverticula underwent D-POEM; two cases with concomitant achalasia received combined POEM and D-POEM; ZD patients underwent z-POEM; and the mid-ED case received tunnel-technique myotomy. All procedures were technically successful, with mean operative times of 84 min (epiphrenic), 23 min (ZD), and 30 min (mid-ED). Intraoperative assessment demonstrated complete flattening of the diverticulum without residual fluid, and no clinical recurrence was documented during a median follow-up of 280 days. CONCLUSIONS: POEM-based endoscopic myotomy appears to be a feasible and minimally invasive treatment option for selected patients with ED. In patients with concomitant achalasia, combined POEM and diverticular myotomy may be feasible in selected cases.