Clin Endosc.  2020 Nov;53(6):646-651. 10.5946/ce.2020.262.

Role of Peroral Endoscopic Myotomy (POEM) in the Management of Esophageal Diverticula

• Miutescu BP
• Khan S
• Mony S
• Khashab MA

• KMID: 2511223
• DOI: http://doi.org/10.5946/ce.2020.262

Abstract

Esophageal diverticula are uncommon; however, when present, they can cause symptoms of dysphagia, regurgitation, and chest pain. Based on location and pathophysiological characteristics, they are classified as pulsion- and traction-type diverticula. In the past, the open surgical approach was the only treatment available; however, in the past few decades, transoral incisionless approaches in the form of rigid and flexible endoscopy have gained popularity. Diverticular peroral endoscopic myotomy has emerged as an alternative treatment option. In this paper, we reviewed the role of peroral endoscopic myotomy as a treatment option for different types of esophageal diverticula. Although a safe and effective procedure, this novel submucosal tunneling technique for the treatment of esophageal diverticula requires further validation, and head-to-head comparisons between the different approaches for the treatment of esophageal diverticula are warranted.

Keyword

Diverticulum; Endoscopy; Esophagus; Myotomy

Figure

• 

  Fig. 1. Endoscopic images of the Zenker’s diverticulum using the peroral endoscopic myotomy technique. (A) Endoscopic view of Zenker’s diverticulum with a clear cap attached to the endoscope tip. (B) A mucosal bleb is created over the septum. (C) Tunneling is performed along both sides of the septum using the triangular tip knife. (D) Following septum exposure, septotomy is performed using the rotatable scissors-type knife. (E) Septotomy is extended to the base of the septum. (F) Closure using clips.

• 

  Fig. 2. Endoscopic images of the diverticular peroral endoscopic myotomy technique. (A) Endoscopic view of an epiphrenic diverticula in the distal esophagus, with a clear cap attached to the endoscope tip. (B, C) A mucosal bleb is created approximately 2 cm proximal to the diverticulum and mucosal incision is performed. (D, E) Tunneling is performed along both sides of the septum, 2–3 cm beyond the gastroesophageal junction using a triangular tip knife. (F) Septum division is performed using the rotatable scissors-type knife. (G-I) Complete esophageal myotomy is extended 2–3 cm beyond the gastroesophageal junction. (J) Clip closure of the mucosotomy.

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